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o'clock at night and continuing till five or six o'clock / still retains it. The drawing, No. I., obligingly made tbe following morning, when she became perfectly easy. by my friend Dr. Branson, shews very accurately a Her nights were wretched'; her appetite bad; muscles microscopic view of a portion of it magnified 250 emaciated; and that peculiar discolouration of skin, diameters, which proves it to belong to the class of and painful and anxious expression of the face solfbrous tumours. commonly found in scirrhus uteri was very remarkable in tbis lady. Sbe bad no leucorrheal discharge, but the bladder and rectum were irritated and difficult to manage. I could only succeed in introducing and that with the greatest difficulty-the bymen being unruptured) Salmon's speculum ani into the vagina, but I managed, with the aid of a good lamp, to clearly ascertain the absence of the least increase of size, form, or density of the cervix uteri, and the os uteri was quite normal. I assured her she was not suffering froin cancer, prescribed acetate of morpbia, iodine, and iron, which soon relieved ber acute sufferings, and she returned home to her friends at some distance.

In July, 1846, I was sent for to see her at her residence, and there met her two piedical attendants, who had succeeded in convincing her she was labouring under cancer of the womb, and that she had not long to live. She was greatly emaciated, constantly bleeding from the uterus, her nocturnal pains had become intolerable, and she ! There being no pedicle to this tumour, I could not told me her life was a burden to her. I succeeded expect to detach it again advantageously; I therefore in dilating the vagina with a sponge tent, introduced determined to try the effect of iodine internally and with great difficulty Simpson's Speculum Vaginæ, and externally, in the form of tincture, balls, and injections, through that liis uterine sound, five inches and a half assisted by quinine and iron, and acetate of morphia, to into the uterus, which I examined from the abdomen relieve the pain. I have pursned this plan for four in front and through the rectum bebind, and found inonths; the result is she has less uneasiness of every perfectly moreable. A deluge of blood followed this description; her nights are good; her appetite, examination, but I was quite satisfied the neck and strength, and flesh have improved ; and the tumour, as mouth of the uterus were not diseased. I assured ascertained by the uterine sound, has decreased in size her she had no cancer ; but that her disease con- an inch and a half; the os and cervix uteri remain sisted of a tumour of some kind in the uterus. I perfectly normal. She is now quite convinced that her gradually dilated the vagina and os uteri by means disease is not cancer, and lives in hope that she may of sponge tents and Simpson's uterine dilators, until eventually be quite cured. I could see and feel the tumour in the uterus. I then introduced the uterine sound, passed it all

Case II. round the uterus to ascertain the nature of the A delicate hysterical female, aged 35, married fire tumour, and during that operation I accidentally years without ever having been pregnant, was attacked detached the tumour from the lining membrane, soon after marriage with severe burning, agonizing, and and it came away with considerable hæmorrhage, lancipatios pains, referred to the neck of the womb, in one piece, weighing four ounces. The bæmor and extending froin pubis to sacrum, thence down the shage ceased under the influence of ergot; the thighs. These pains came on periodically edery night nocturnal periodical pains became very much dimin. about ten o'clock, and increased in intensity until isbed, and I was in great hope my patient would | about six in the morning. She was quite free from get well; but in the course of a few weeks the old pain during the day. The pain on coition was excruciperiodical pains and discharge returned; and on

ating. She bad very frequent bæmorrhage, and when a fresb examination with the speculum and uterine this ceased, a sanious kind of matter, mixed with a sound, I discovered a new growth of tumour. Auid resembling pus in appearance, kept her constantly

I am sorry I cannot shew this tumour, I sent it up wet and uncomfortable ; added to which the bladder and to Professor Simpson, of Edinburgh, for the purpose rectum were very irritable. of obtaining bis opinion respecting the case, and be! When she consulted me, in July, 1846, for wbat she

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CASES OF NON-MALIGNANT TUMOURS OF THE UTERUS.

345

bad been led to believe was cancer, she was emaciated, "A lady, aged 63, laboured under some obscure,
had a greenish sallow complexion, with that pceuliar symptoms for more than two years, which induced her
appearance in the countenance indicating nalignant medical attendant to believe that she had some disease
disease. I examined the uterus by means of the of the bladder. One day she was seized with sudden
speculum, found the os bealthy, but the cervix and profuse discharge of blood from the vagiaa,
elongated and rather narrow; the least touch with either accompanied with sharp uterine pains, like those of
my finger or the sound gave her great agony; I there incipient labour or miscarriage. I was then called to
fore desisted, and gave a cautious opinion. Iron, her, and informed by her surgeon that she had some
quinine, and morpbia, with astringent and sedative disease of the womb, which he believed to be scirrhus.'
injections, relieved the symptoms so much, that in On examination I discovered that the os uteri was a
October last I was enabled to introduce the uterine little dilated, and very thin, with something protruding
sound, which penetrated the uterus to three inches and from the uterus, the nature of which could not at that
a half, and I easily discovered by examination from the time be correctly ascertained. She had long been
rectum and abdomen that the uterus was not attached suffering periodical pains in the region of the pelvis. I
to any other organ, but was, at its fundus, much larger directed some ergot of rye, and on the following
than natural. I dilated the os uteri with Simpson's morning I found that the tumour bad descended much
dilàtor, and then found a tumour apparently attached lower. I passed Simpson's sound into the uterus, and
all round. I got hold of a bit of this with a pair of carried it quite around it twice. Two hours after a
long forceps, cut it off, macerated it in spirit of fur large fibrous tumour came away, without pain, and the
pentine, and examined a thin slice of it under the hæmorrbage ceased ; it was larger than a common-
microscope, a specimen of which Dr. Branson has also sized kidney, with an attachment about the size
kindly delineated for examination. (Drawing No. II.) of a shilling, and it appeared to come away clearly

and entirely. All the former symp,
toms disappeared, and she rapidly
improved. This amendment, how-
ever, did not last long; for about
a month afterwards, periodical pains
re-appeared about the region of the
uterus, and some discharge. A most
careful examination failed to detect
any cause for these symptoms, which,
although occasionally relieved, never
subsided for any length of time. It
is now more than three months since
the tumour was removed; the pains
are more severe, and generally occur
every afternoon or evening, and re-
semble those of cancer in its early
stage; the discharge, too, is more
profuse and bloody, so that its effects
are visible in the countenance and
constitution. Her sleep and appe :
tite are becoming impaired. I have
repeatedly examined her with great
care, but can detect nothing more
than an enlarged, painful, and indu-
rated state of the uterus, but I do not

find any ulceration, or even thickening, Finding this also was a fibrous substance of the same , of the neck. Thinking there might be another growth, description as the first case, I resolved to let it alone, I dilated the os uteri with sponge tent, and examined and try the effect of iodine internally and externally, that organ internally, without discovering any cause by means of introducing the tincture into the uterus, for the symptoms. She is generally free from paia injections, and balls. The result is, that by these until towards evening, when dreadful pain comes on. means, aided by tonics and the cold shower-bath, the At first this did not happen every evening, but now tumour has almost if not quite disappeared, and with it she scarcely passes a day without much pain." the whole of the distressing symptoms which were so

|

The

The only tumours growing from the internal memsimilar to cancer as to have induced more than one

brane of the uterus described by authors, are soft and practitioner of eminence to call the disease by that

hard polypi, encephaloid, cauliflower excrescence, name, CASE III.'

hæmatoma, scirrhus, and fibrous; the latter often This case has been related to me bs my friend Dr. running into osseous and calcareous tumours. The Toogood, of Torquay, which I will give in his own symptoms and progress of these diseases are quite words,

different from those I have described; and I have

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yen

consulted the works of Dr. Montgomery, Dr. Davis, ordinary cases, sufficiently attest the intimate con
Dr. Lee, Dr. Churchill, Dr. Lever, Ingleby, Dr. Gooch, nection subsisting between the womb and its appende,
Dr. Ashwell, Dr. Marshall Hall, Dr. Henry Bennett, ages with the organs of organic life, and the frequent
Boivin and Dugés, by Hemming, and Mr. Lee's Prize

functional disturbance of the sensorium and the spinal .. Essay, and can find no notice of a disease like the

system of perves, as ciearly manifest its influence on

animal life. I am not aware that there is any case re three cases detailed, all of which might be so easily

corded similar to the one I am about to relate, but I. mistaken for scirrhus and cancer, unless examined

know of no reason why such should not have bappened; carefully by the aid of Simpson's speculum sound indeed Dr. Ramsbotham observes, that puerperal mania and dilator.

sometimes occurs during pregnancy; and it may be The first morbid change which takes place in scirrhus inferred from the introductory remarks o: Dr. Gooch, . uteri is induration in and around the muciparous to his chapter “On disorders of the mind in lying-in . glands or vesicles, called by some ova Nabothi, which women," that he also was aware of the fact. exist in great numbers in the cervix and margin of

Puerperal convulsions mostly occur during labour, the os uteri.

or, as in the case of puerperal mania, soon after deliThis induration is caused by the deposi

very, but convulsions precisely similar are also some tion of scirrhous or tuberculous matter, which thickens

, times observed, (thougha rarely,) at different periods of the parts, and gives them a greater volume, so that

Jutero-gestation. Some years since I had a patient. they feel unequal, bumpy, and knotty, like the ends | who was thus affected in several of her pregnancies,, of one's fingers drawn together; but in the cases commencing at an early period after impregnation, described, no thickening or hardness can be either and who, in every instance, went on to her full time, seen or felt. The severe pains are difficult to account and without any apparent injury to herself or child. for, unless the irritation and stretching of the neck of

Puerperal mania and puerperal convulsions are kindred the uterus by the tumour can be considered sufficient;

affections, and are essentially diseases of the nervous but even then, it is still more difficult to account for

system, the primary morbid impression being exercised

in both cases on the peripheral extremities of the the absence of pain in the day time. "

uterine nerves. For the production of the former, the The periodical nature of the acute pain attending

irritation is propagated to the sensorium ; and for the such fibrous tumours, which so nearly resembles that I latter, being conveyed through the excito-motory suffered in cases of cancer uteri, and the relief afforded system of nerves to the spinal marrow and brain, by the treatment with iodine, will, I trust, be considered | induces the epileptic paroxysmos, by the members of this Society, a sufficient apology for introducing the subject to their notice.

CASE. Rotherham, March 4, 1847.

The subject of the following case is a lady of about thirty-one years of age, of delicate organization, fair

and ruddy complexion, with dark bair and eyes, CASE OF PUERPERAL MANIA,

usually enjoying good health. She has been married

three years and bas been three times pregoant. In OCCURRING AT AN EARLY PERIOD OF UTERO-GESTA

ber first pregnancy a disordered state of the intellect. TION, AND RELIEVED BY INDUCED ABORTION.

commenced about the seventh month, and after con

cipuing a fortnight, labour came on, and in a moderate TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

time she was safely delivered of a female child, who is SURGICAL JOURNAL.

now living and in good health. She again proved SIR,

pregnant, and this time the mental alienation showed I propose from time to time to send you a few cases

itself about the termination of the sixth month, mani. and observations copied from my note book, for

festing the same symptoms as in the preceding attackpublication in the Journal. Should you consider

constant restlessness, almost total absence of sleep, andi the present communication of sufficient value, you

such a degree of violence of manner, es often to will oblige me by inserting it.

require four or five persons in constant attendance I am Sir, your obedient servant,

| upon her night and day. After continuing in this THOMAS SALTER, F.R.C.S.

state for two or three weeks, it appeared to the medical Poole, May 20, 1847.

gentleman under whose care she was, necessary to Puerperal Mania as its name inplies, is unsoundness bring op labour, by rupturing the membranes and of mind occurring in the puerperal state, and most evacuating the liquor amnii. This was accordingly frequently from three to ten days after delivery, owing done and in fire days she gave birth to a still-born its origin to a peculiar irritation of the uterus derived child. The violent paroxysms of insanity which before from its prerions impregnated condition. The pecu- threatened ber life, two days after this event ceased, liarity of the case about to be related, and to which it And she gradually recovered her former state of mind. chiefly owes its interest, is the occurrence of mental Soon after her removal to this neighbourhood, from disease antecedently to parturition, and at so early a the north of England, her former place of residence, period of gestation.

she became pregnant a third time, and on this occasion The various sympathetic derangements of the func- the unsoundness of mind showed itself shortly after tions of the body resulting from uterine impregaatioa, in she had passed the fourth month. From this period

CASE OF PUERPERAL MANIA.

347

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my attendance commenced. The preceding account found to be slightly opened, and the cervix seemed also I received from the lady's husband, whose intelligence somewbat shortened, changes favouring the operaand constant presence about her person, guarantee its tion, and evidently produced by the use of ergot. From correctness.

244he state of the patient's mind it was difficult to ascerI was bastily requested to visit this lady at two tala" whether or not there were any uterine pains.. o'clock, a.m., March 5, 1844. I was informed that Remembering the difficulty experienced in my first previously to going to bed she had manifested con essay, and the danger there appeared of injuring the siderable irritability of mind; at the time of my visit cervix uteri, I, on this occasion, employed an instrument, : she laboured under total mental alienation, and was (contrired by my son, Mr. S. J. A. Salter, now a. constantly talking in an incoherent manner. I pre- student in the Medical School of King's College,) : scribed a sedative mixture, with æther and camphor, expressly with the view of avoiding the possibility of wbich appeared to have some quieting effect, but this accident. It consisted of a flexible gum male scarcely any sleep was obtained through the niglit. catheter, but of sufficient firmness to preserve its, After this time she became more violent and un- straight form, even when opposed to a moderatelymanageable, requiring sometimes four or five persons existing body, having a perforation at its extreme, to keep her in bed, incessantly talking, either religiously point, just large enough to allow a common wire stilet or quite the reverse; sbe also had occasional fits of to pass through. screaming, so loud as to be heard by the neighbours The patient, lying on her left side, and near the edge living at a considerable distance from her own of the bed, the catheter was introduced into the vagina residence. She continued in this state, and without with the right hand, and pushed forwards upon the any sleep, day after day.

anterior surface of the fore-finger of the left, and in Saturday evening, five days from my first visit, (since this manner it readily entered the os uteri, and passed which she has had no sleep,) there being no improve through the cervix; withdrawing the finger from the ment, and no signs of abortion occurring, in order to ragina and os uteri, the instrument was pressed forward, ensure the safety of the patient, it appeared peeessary until it met with steady resistance. The stilet was to adopt the practice which had been so judiciously then introduced and passed on, making its exit at the carried out in the previous pregnancy by her then opening prepared for it, when it was immediately medical attendant; but from the length of the cervix found to have perforated the membranes. Renewed uteri, and its undeveloped condition at the period at pressure being then made upon the catheter itself, that which she bad now arrived, I felt that greater diffi. also entered the cavity of the awnion, and on withculties would present themselves in rupturing the drawing the stilet the liquor amnii flowed in a full and membranes than on the occasion referred to. On continuous stream, as urine is observed to do from a making an examination for this purpose, the os uteri catheter introduced into a distended urinary bladder. was found high up, and situated backwards towards The fluid collected amounted to about a pint and a the sacrum, and was therefore with difficulty reached; balf. Nothing could have been more successful than it was, moreover, so closed, as not to admit the point the use of this simple instrument, and I would venture of the finger. The cervix was, as far as could be to recommend its employment to my professional ascertained, of the usual length of that of the unim- brethren, as equally adapted for the purpose for which pregnated uterus. By passing the stilet of a catheter it was had recourse to, as the ingenious cutting instruon the front part of the fore-finger of my left hand, mept contrived and recommended by Dr. Ramsbotham, whilst that member was in the vagina, and pressing which I did not happen to possess, and the use of against the os uteri, I made an attempt to puncture the which, in unskilful hands, might not altogether be membranes. Much difficulty was experienced in unattended with danger, and be especially hazardous passing the stilet through the cervix, which, however, in cases where the cervix and os uteri are undeveloped, I once effected, but do fluid followed its withdrawal as in the present instance. As I therefore did not succeed in my object, and fearing After the evacuation of the liquor amnii, the patient the cervix uteri might be injured by further trials, I took one or two more doses of the ergot of rye, but desisted for the present from the purpose I had in view, as its previous exbibition bad not occasioned any very and deterinined to make trial of the ergot of rye, in decided uterine action, as evidenced by the absence the bope by the influence of that drug to produce of the usual pains, and the liquor amnii being so abortion. It was exhibited in the form of infusion, in entirely evacuated, the further use of the inedicine proportion of tbree drachips of the powder to eight was not urged, in the confident belief that the ovum Ounces of boiling water, giving one ounce of the would be soon expelled by the natural efforts. infusion, with a drachm of the tincture, every two In the middle of the night of Thursday, the 14th, (nine hours. From the violent and unmanageable condition days after the commencement of the mental derangeof the patient not allowing it, the medicine was not ment, and fifty hours subsequent to the puncturing given either as often or as regularly as could have been of the inembranes,) expulsive pains came on, and the wished, and to sensible effect being produced by it, on delivery was accomplished at two o'clock on the Monday, the 11th, a scruple of the powdered ergot was morning of the 15th, being fifty-two hours after lhe added to each dose of the infusion.

rupture of the membranes and the discharge of the Tuesday evening, March 12tb. Another attempt was liquor ampii. In a very short time subsequent to this made to puncture the membranes, and which happily there was a manifest improvement in the state of the proved successful. On this occasion the os uteri was patient, and though still incoherent, and having

occasional paroxysms of violence, she became more she came out of her cabin in two minutes, to tell me quiet and manageable, and slept occasionally for a it had stopped the paia instantly. I requested her to few hours. On the second day there were intervals re-apply it if necessary. The pain returned once when of comparative soundness of mind. Since this period it again immediately and entirely reliered it. If 80 her improvement became gradual, and though slow, minute a quantity as is contained in the wice, could regularly progressive, and she is now, (April 5th,) | be attended with such good effects, I think much in her usual bealth in every respect. She had, however, more might be expected from its use in the concentrated two or three violent paroxysms after her delivery, and form of emetine. frequently awoke from her sleep in a fright, screaming violeatly, and she, moreover, passed many nights without sleep; at such times, as well as previous to

Hospital Reports. delivery, to procure rest, opiates were occasionally given, but they only appeared to answer the purpose HÔPITAL DE LA PITIÉ, PARIS. once or twice, and from their beating and other effects, seemed to be rather injurious than otherwise.

A CASE OF MENINGO-MYELITIS. During the whole progress of this case, the pulse was seldom more than 100 in a minute, and often not (Communicated by SEPTIMUS Lowe, Esq., M.R.C.S.E.), more than 80; the skin was cool, and there was upon

History of the case; present attack; symptoms on the whole less disturbance of the functions than

admission; treatment ; remarks.- Importance of a might a priori have been expected from the violence

proper diagnosis from lesion of the brain ; from a of the symptoms, and the long absence of sleep.

tumour or ramollissement, $c., of the spinal cord; May 20th, 1847. This lady is now living, and in

from epilepsy, spinal irritation, &c.-Indications for good health, but has aborted once without any unusual

treatment. circumstance happening, the only time of her being pregnant since the above case occurred.

M. B., a boy, aged 16, was admitted into the Hôpital de la Pitié, under Professor Piorry, April 21st, 1847. He is slightly made, rather short for his age, of

lymphatic temperament, and fair complexion. He IPECACUANHA IN THE BITES OF VENOMOUS appears to be very cheerful and intelligent, and ANIMALS.

answers questions with great perspicuity and accuracy. He states that for eight years he assisted his father to

carry wood, and was constantly exposed to all kinds TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

of weather. During the last year he has been a fringeSURGICAL JOURNAL.

waker, residing at Paris, working in the same room SIR,

with soveral other persons, and sleeping alone in a If you consider the following case likely to be useful

sinall but well ventilated apartment. His food has on furtber inquiry, in the relief of venomous bites of reptiles and stings of insects, I wish you would publish

generally been neither very abundant nur very whole.

some. He was always rather weak and small for it. I must owo it made a great impression on my

bis age. He has occasionally suffered from severe mind, and I should be glad if the profession generally

colds, but he never had an attack of epilepsy, conval. would try the rewedy and publish the results if suc

sions, or any serious illness, previous to the present cessful. I have never had another case, but many of

disease. About three or four days since he was purged my friends have found it useful in the sting of wasps.

considerably; the purging ceased yesterday. Last I remain, yours faithfully, HENRY COLLET.

night he was suddenly seized with a burning tingling

sensation in the right hand and right side of the head; Worthing, June 12, 1827.

he soon afterwards experienced cramp in the right Some years since the daughter of Templer, fore-arm and hand, and towards morning the left Esq., about eight years old, had her hand upon the arm and hand, as well as the inferior extremitios, companion ladders of the East India ship, Malcolm, became painful and contracted; he found he could when she suddenly felt it bitten by something which not close his hands, the fingers being rigid and partially was not observed, but the two specks on her finger Besed; be also states that he had considerable diffi. plainly showed the marks of a centipede's fangs, of culty in forming his words, so that his utterance was wbicb many of very considerable size had been caught. somewhat impeded. He never lost consciousness As surgeon of the ship I was called to her assistance, in the least. and found ber in very great suffering, and after ex- At present he appears perfectly sensible; the face hausting all the remedies usually considered useful,-oil, is quite natural; the pupils are sensible to light; he spirit, laudacum, ammonia, &c.,- I recollected having complaius of great pain and burning in the head, been informed by an old officer in a prerious voyage, that especially on the right side, but he says it does not the best cure for the bite of a rattlesnake was ipecacu. extend deeply; the thumbs and fingers, as well as the anba. I fetched a bottle of wine of ipecacuanlia from fore-arms, are rigid, contracted, and partially flexed, the chest, and gave it to the mother to apply locally, so that he cannot close his hands; he feels severe at the same time telling her that I had not the slightest crampy pain in the hands and fore-arans, and a sepsafaith in the remedy; but to my surprise and delight I ciod of burning, lingling, and formication, in the right

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