CASE OF INFLAMMATION OF THE APPENDIX little place is always very painful, and the griping though VERMIFORMIS, FROM GALL STONES LODGING IN IT-ENDING IN By WOLFRED NELSON, ESQ. The post mortem appearances (with lithograph), reported by less often is very severe." To the calomel was added half a grain of morphine: a blister applied over the right iliac region; bags filled with hot oats to be continued; soluble tartar, as usual. 3rd, 2 A. M., was sent for, had become suddenly worse; "pain in the part intense: On Friday, 1st inst., 3 P. M., was called to the Rev rurning down to the anus and to the end of the urethra : Mr. Strong: complained of "a fixed pain at the bot- if you could only open that small place how it would tom and on the right side of the belly. The tip of relieve me; mouth dry; but not thirsty:" surface your finger can cover the part-the pain is much in- cool; pulse 90 and weak: bottles filled with hot water creased when there is a peristaltic motion of the bowels to the feet, &c. Notwithstanding the symptoms of col-violent gripings come on about every 20 or 30 min- lapse, twelve leeches were placed over the right groin, utes-no thirst, but the mouth is dry." Such was the the pain being so intense there. The blood taken yesdescription he gave of his case. Mr. S. was 31 years terday highly buffed. of age, of a bilious temperament, habitually costive; The patient had been made aware of the nature of would occasionally take blue pill followed by seidlitz his case from the first: I requested that other medical powder: had had no move for the last 24 hours. The aid might be had in about two hours I had the pleasskin was moist and cool, pulse about 80 and soft, ure of having Dr. Crawford's valuable assistance. The tongue white. Of calomel, jalap and rhubarb 10 grains Doctor concurred in my view of the case and in all that each, were given; a drachm of soluble tartar in a pint had been done. A few drops of the arom. spt. amm. of water for drink. Bags of heated oats or bran to be were given as a gentle diffusable stimulus. Bags of kept constantly over the pain. Saw him again at 7 bran steeped in hot water were applied over the leech P. M. Had passed a copious, soft stool, deep brown bites, which bled rather freely. Four grains calomel, colour and very offensive odor, with much flatus. "Much two of ext. hyos. and two of opium were given every four better, the griping less severe and frequent, but the hours. Once between each dose, the cal. and hyos. pain still in the same spot." Five grains cal. with one alone were to be taken. 9 A. M., we returned, found a of ext. aconite and half a grain ext. belladonna in a striking alteration in the symptoms. The surface was pill were given. Continue hot applications, sol. tartar, now warm: the pulse 120, small and hard: the abdo&c. Enemas with castor oil to be administered dur-men becoming tense; pain more diffused: continued ing the night should the pain increase. medicine, fomentations, &c. 2nd, 9 A. M. "Passed an uneasy night; occasional Anticipating the necessity for the further application slumber but no refreshing rest: griping less often but of leeches, a number were ordered to be provided against extremely severe: the pain always in the same place:" the next visit. J. skin, pulse, and tongue as yesterday. "No pain on 1 P. M.-We were joined by Drs. Campbell and pressure but on that particular spot;" countenance de- M'Donnell: were unanimous as to the nature of the case: jected, eyes sunken, and tinged with yellow. Two external heat much increased: "pain had shot all over enemas had been given in the night, some liquid fæces the abdomen:" pulse 140, small and hard: breathing passed. Repeated the calomel, &c. 12 P. M., no hurried. Eighteen leeches were applied over the right amendment: two grains calomel every hour-fomenta- hypogastrium and a large blister over the epigastrium; tions. 3 P. M., "Fixed pain and griping more violent," medicine as usual. 6 P. M., met Drs. Crawford and yet was there no reaction nor pain of the abdomen, save M'Donnell: all the unfavourable symptoms much ag "in that one spot." Bled to the extent of 22 ounces: gravated: at 9 met Dr. C. again: evidently sinking: became faint, had a copious liquid stool, and passed died at 2 P. M. large volumes of flatus; felt much relieved; continued It is worthy of remark, that so long as the pain was medicine. 7 P. M., "better than at any time yet, but that' confined to the region over the appendix vermiformie 258 Case of Inflammation of the Appendix Vermiformis. the pulse, skin, and general aspect were those of inflam- through them-explaining in a very satisfactory manmation of a mucous surface; but so soon as the pain ner the cause of the co-existent jaundice, which wa "spread at once all over the abdomen," then the symp-very manifest over the surface of the body, and in the toms characteristic of inflammation in the serous tissue, tunica adnata. or peritonitis, became very striking. Vomiting of a little mucus had taken place on the invasion of the complaint, but not afterwards-at no time was there hiccough. Our patient was made fully aware of the impending result, and he awaited it with all the calmness and dig. nity of a good Christian and a good man. I was kindly assisted in the post mortem examination by Drs. Crawford and M'Donnell. The appearances fully justified the diagnosis. That there was impaction and inflammation of the appendix vermiformis in the first instance; and that the symptoms of jaundice were due to obstruction in the biliary organs. Dr. Crawford has ta n notes of the morbid appearances, and wil be so good as to append a detail of them together with such remarks as he may deem proper, that the profession may have the advantage of profitting by this highly interesting and singular case. Montreal, 7th Jan. 1847. a number from 80 to 90. From this time the inflamma on spread with amazing rapidity, and manifested itself by general abdominal pain, and intolerance of pressure Although there was considerable flatulence, the abdomen did not at any time become tympanitic. The great peculiarity of the case however was, its originating in the appendix vermiformis, an occurrence equally rare, as its invariably fatal consequences are inexplicable. The rapidity with which peritonitis ensues after the formis, is noticed by Dr. Wardrop, in his edition of introduction of foreign bodies into the appendix vermiBaillie's Morbid Anatomy: "Twenty-four hours after that a small bean had been swallowed, peritonitis ensued, and proved fatal in three days, when the bean was discovered in the appendix;" he also notices a cherry stone producing similar consequences. Autopsy. On laying open the abdominal parietes, the peritoneal coat of the intestines generally, was of That such an apparently innocuous body as a gall bright rose colour; and was in many parts covered by stone, a pip of an apple, a small bean, or a plumb stone, an exudation of coagulable lymph, particularly where can excite fatal inflammation, shortly after its introducthe bowel doubled on itself; these knuckles were in tion into this portion of the intestinal canal, a few well consequence slightly adherent together: a few ounces attested cases fully demonstrate: while the peculiarity of turbid serum commixed with lymph were found in the of organization which renders this part so obnoxious to peritoneal cavity. The appendix vermiformis was so inflammation, from what would appear so insufficient altered in appearance and structure, as scarcely to be a cause, is not so clearly understood. recognizable; it was about the size of a man's thumb, both as to its length and breadth; and of a dark or purplish red colour, easily breaking down, on any rough handling; being evidently in a state of gangrene throughout its whole structure: its upper portion alone, at its junction with the cæcum retaining its normal texture, its cavity was capable of admitting a finger: it contained a small quantity of dark thick fluid, but not sufficient to distend it. Two small portions of gall stone, each about the size of a small finger nail, were Dr. Copland mentions four cases similar to the above, found in this cavity. The cæcum did not appear to originating in the introduction of foreign bodies into be more involved in the peritoneal inflammation, than the appendix, which were followed by gangrene of this the other bowels; its mucous tunic was quite normal. portion of the bowel, and general peritonitis, the cæcum The liver was mottled, pale, and of a blue colour. The not being in any especial manner involved; in all these gall bladder distended with extremely tenacious thick cases, however, there was obstruction of the bowels, dark bile resembling tar, which adhered firmly to the obstinate retching, vomiting, and tormina. Symptoms lining membrane of the gall bladder, and to that of the of ilius having been superadded to those of enterites, ducts, which it almost completely blocked up, so that it none of which, however, it will be seen, occurred in the was with some difficulty that the bile could be forced present case. CASE OF PROTRACTED UTERO GESTATION. By JAMES A. SEWELL, M. D., Quebec. To the Editors of the British American Journal of Medical and Physical Science. tamenia did not return, and she was confined on the 8th Sept., 1842, of a large healthy female infant. From what period are we to date, is a question which now naturally presents itself. If we follow the I see in the November number of your Journal a report usual course, I should count from midway between the of the case of the "Com. vs. E. F. Hoover," which in- last time she was unwell, and the next monthly period duces me to send you the following, which I extract from at which the catamenia should have returned. Say my note book just as I recorded it at the time of its then she was taken unwell on the 5th Oct., from which Occurrence. The case is of interest in a Medico- she had perfectly recovered on the 10th, and allow 15 Legal point of view, as I conceive the data, (always days to elapse, which will bring us to the 25th of Ocuncertain), are, nevertheless, as correct as they can well tober, the day from which I think we are justified in be in any case of the kind; and goes to support the reckoning. justice of the laws of those countries which allow a If then these data are correct, Mrs. A. B. carried her greater latitude than our own, for the occasional devia- infant in utero 318 days, or more than ten and a half tions of nature from her established rules, with regard calendar months. If on the other hand, impregnation to the period of utero-gestation; whereby, as in the did not take place till the 4th of November, or the casc above alluded to, the guilty are punished, while day immediately preceding that on which the return the, (it may be), innocent woman, (as in the following of the catamenia was looked for, (and which I conceive case), would be protected from the fiery darts of slan-is the latest date we can ascribe to it), even then gesder, had the husband unfortunately have died shortly tation will have been protracted to 307 days, or twenty after her conception. seven days beyond the usual 40 weeks. Mrs. A. B., aet. 22.-Second pregnancy delivered Sep. 8, 1842. Natural labour. This lady was confined by me in July 1839, with her first child. She stated to me during her pregnancy that she "expected" about the 19th of June, but the event did not take place till the 19th of July. It became a matter of joke between us that she was carrying her child ten months; but it was merely a joke, as I conceived she had miscalculated her time, which was not to be wondered at with her first child. I am now, however, of opinion that she did in reality carry her infant ten months, and, moreover, that she has done the same thing on the present occasion. En passant I would merely remark, that this season, in Quebec, has been noticed for the great number of cases in which ladies have exceeded, by many days, (and in some instances even weeks), the period for which they had secured the services of their professional attendants. Quebec, Dec. 1846. POISONING BY ACETATE OF LEAD. By ROBERT W. EVANS, M. D., Richmond, C. W, On the 19th Nov. 1846, I was requested to attend Mrs. W., aet. 27, married 8 years, without isssue; of intemperate habits. The messenger informed me that The circumstances of her second pregnancy are as she had by mistake taken oz. of sugar of lead for follow. In July 1840, she left her husband in this loaf sugar. I proceeded at once to her house, "well country and proceeded on a visit to her friends in armed" with sulphate of zinc, &c. The room was filled England; was absent about 14 months, and returned with friends summoned from the neighbourhood, all to this city and her husband on the 19th of Sep. 1841, endeavouring to administer relief to the suffering having menstruated on ship-board during the first week patient. She complained of a twisting pain around the umbilicus, with retraction of the abdomen to of that month. On the 5th of October the catamenia returned, wards the spine; pain in the back, nausea, tremors, being exactly the period at which she looked for them. great uneasiness and anxiety, dilatation of the puIn November, however, they did not make their ap- pils, metallic taste in the mouth, constriction of the pearance, but about this time she began to complain throat, hiccough; pulse 70, small and hard, (inmuch of "morning sickness," and to be troubled with creased in force in consequence of ardent spirits toothache, with which symptom her first and subsequent drunk during the day); laborious breathing; thirst; a pregnancy declared itself; her breasts also began to fill desire for cold drinks; to these symptoms succeeded up and be hard, with the usual dark areola around the spasms, and pains principally of the hands and feet. nipple, and she at once declared herself to be in the Treatment. Without delay I administered sulphate family-way, in which opinion I fully coincided, and of zinc, gr. xx., which produced immediate emesis, which I had no reason to change afterwards. Her ca- encouraged by copious draughts of tepid water: after 260 Statistics of the University Lying-in Hospital. the operation of the emetic, sulphate of magnesia 3ij.: a warm bath at 98, acid (sulphuric aromat) gtt. xij. omni hora, in a wine-glass full of water. This treatment gave considerable relief. 20th, at 8 o'clock a. m.-Complained of slight pain in the bowels; medicine operated well-ordered calomel gr. iv. opii gr. i. At bedtime ol. ricini 3i. 21st. Much improved; pain in the bowels removed; states that she had been afflicted with "Fluor albus" for 6 months, and that the leucorrheal discharge has ceased since she took the lead. The aromatic sulphuric acid to be continued three times a day. It is an established fact that the preparations of lead do not pass off, or at least very sparingly, in the secretions. In this respect lead forms a striking contrast with iodide of potassium. When the latter accumulates in the blood it produces sneezing, headache, watery eyes, and a variety of other symptoms, and at the end of a few days these symptoms vanish. The poison of lead, on the contrary, remains in the system, and its effects are consequently more lasting. "The presence of lead in the solids and fluids has been detected in a case at King's College Hospital, London, treated by Dr. Budd, where the patient had been a house-painter for some years, and died from colic and epilepsy. The metal was detected in the brain by chemi eal analysis, but Mr. Bowman could obtain no evidence of it by the microscope." However, the fact that acetate of lead has been lately detected in the urine, confirms the idea that it is the least poisonous of the salts of this metal. Poisoning from lead is never intentional, but only accidental. Its presence can easily be detected by rubbing it in mortar with a little spirituous solution of guaiac, and a few drops of liquid ammonia, which produces a beautiful grass green, passing to glaucous, if lead be present. Richmond, C. W., Dec. 18, 1846. [The above case is interesting simply from the fects induced on the Leucorrhea, and it is chiefly on this account we give it insertion.-EDS.] STATISTICS OF THE UNIVERSITY LYING.IN HOSPITAL, MONTREAL. If we exclude from the calculation the breech and feet cases only, the result will be ninety-eight presentations of the head in every hundred labours. Ergot has been administered only to two patients, and venesection had recourse to, once before and once after delivery. Two of the mothers had convulsions after delivery; and twelve cases of puerperal fever occurred. The labour terminated within six hours in one hun dred of the cases, within twelve in two hundred and forty, and within twenty-four hours in three hundred and thirty-six. Four were forty-eight hours, and one only of longer duration. In the three hundred and fifty four cases, the average duration of labour was eleven and a half hours. A patient, who daily expected to be confined, entered the room where another was suffering in labour, and, without any premonitory symptoms, the liquor amnii suddenly escaped, and, with only two pains, the child was born before she could be removed to a bed. Two of the mothers died, one from uterine inflammation, after a very severe labour, and another in a comatose state, twelve hours after an easy delivery, in consequence of falls on the head previous to her admission. The deaths being thus one in a hundred and seventy-seven. The eldest patient was forty-five years of age, and the youngest fourteen years and seven days. Although the face of the child was towards the pubis, she had an easy labour of seven hours duration, and her infant weighed six pounds. There were three cases of twins. ef-nal by Dr. Sewell, who found the patient with symptoms One of them has already been reported in this jourof labour in her masters house, and, very much against her inclination, sent her to the hospital; where she continued to deny that she was pregnant, until she was delivered, and then the presence of a double placenta, with two cords, disclosed the secret of her having a short time previously given birth to another infant. Her former residence was immediately searched by the police, and the other twin found concealed in her By M. McCULLOCH, M.D.M.R.C.S.L., attending Physician, and This institution was first opened to the public in trunk. The only instrument used to assist delivery was the Three hundred and fifty-four patients have been forceps, once in the three hundred and fifty-four cases. already delivered. Of the number there were One hundred and seventy-eight of the children were males, and one hundred and seventy-six females, Remarks on Dr. MacDonnell's Paper on the Use of the Microscope. Eighty-three of the children were weighed, and the average was seven pounds and a half; only four of that number weighed twelve pounds each. 261 promises to result from the use of the microscope in the elucidation of many departments of practical medicine. I hold it no inconsiderable step in favour of Malformation was observed in only two of them, science, to bring ourselves to doubt of the reality of one had spina bifida, and the other was anencepha-some facts advanced for truth, without any reference lous and survived nearly an hour; it was at the full term, whatever to the celebrity of names: nay, it is to doubt, and otherwise well formed. that innumerable medical errors have not been permitted The longest umbilical cord was thirty, and the shortest to travel down to us, from time out of mind, as matters six, inches. of unquestionable veracity and it is to a rigid and imOnly five children were still-born, being in the pro- partial investigation, that many of the facts that are portion of one in seventy-five births. ushered into the world, lose their importance, Montreal, January 25, 1847. We cannot all with the same electrical rapidity as the learned doctor, penetrate at once into a new Theory REMARKS ON DR. MACDONNELL'S PAPER ON THE of Physics, however simple its principles, without disUSE OF THE MICROSCOPE. To the Editors of the B. A. J. of Medical and Physical Science. Gentlemen, I received the enclosed communication from Dr. ➖➖➖➖➖➖➖➖ some days ago, but disliking to place it before the public through the medium of the daily journals, I desire to know whether you will insert it as it stands, in your next number. I remain, &c., Montreal, Jan. 7, 1847. F. T. C. ARNOLDI, M. D., sipating many clouds, and bringing to our examination the clearest and steadiest rays of the light of science and experiment. Experience, indeed, has taught many of us, that discoveries founded on novel principles and experiments, and bolstered by strong professions of success, have ofta disappointed the expectations built upon them; and the hope of something solid and useful as well as new, has been puzzled by the vanishing tenuity of the thread of reasoning which has been drawn out beyond the staple of the argument, till apparent axioms have sunk into postulates, and these have dwindled The October number of the British American Jour-away into hypotheses, rather darkened by variously nal, having but very recently reached me, I apprehend, interlaced inductive reasonings; and in the end, Ixionthat any observations which I may have to offer on Dr. like, we embraced a cloud, or like the sage of old, ferMacdonnell's article upon the use of miscroscopes, will minated our labour with the no feigned cry of "all this seem, at the present time, rather out of place: but lay-is vanity and vexation of spirit." ing aside this considerations, bongré malgré, I deem It is not my intention to interpose any doubts which the exalted and self-sufficient tone which that gentleman I entertain from practical results, to the success assumed has assumed, in reference to illuminating various operations of nature, and to explain certain properties of matter through the microscope, ought not to remain entirely unnoticed. by Dr. Macdonnell on the application of the microscope, in ascertaining the properties of matter in certain diseased actions of the animal economy, but merely to content myself with submitting such sources of informaOn a subject of so much importance as one which tion upon the subject as cannot fail to be regarded as also treats upon the means of discovering the hitherto the highest in the scientific world: I allude to the Royal concealed causes of those morbid acons or excitements Society of London; and than which, no society's transwhich disturb the animal economy, from its normal actions, contain richer and almost unrivalled treasures operations, the author, in my humble opinion, should of facts and discoveries in every branch of demonstracourt the practical investigation of his professional tive and experimental knowledge, and are more conbrethren in terms less intemperate, and less dogmatical stantly referred to, as the highest and most satisfactory than those he seems to have adopted in his communi-authority by all writers on subjects connected with the cation. arts and sciences. I am ignorant of what is meant by the pretended value of his information not being intended to such scoffers of science. I shall now offer a short abstract of Mr. Lister's paper on the compound achromatic microscope of Mr. William Tully. Mr. Lister enters into a searching review of I may class myself among those against whom so the comparative merits of various microscopes conoffensive an insinuation cannot be applied, but I must structed by Cuthbert and Dolland in England, and by confess to be one who entertains strong doubts as to Chevallier, Selliqué, Amici, Utschneider and Franhope the success and benefits the learned experimentalist on the Continent-but the author speaks with much |