A CASE IN WHICH HOUR-GLASS CONTRACTION OF THE UTERUS IN A CASE OF TWIN BIRTH ARRESTED THE EXPULSION OF THE SECOND FŒTUS
301 and the abdominal walls were laden with fatty masses. 1 The liver was smooth, engorged with blood, and oily, and 1: the gall-bladder was full of greenish-yellow bile. The spleen 1 was dark, enlarged, and friable. The kidneys when stripped I of their capsules both displayed several deep cup-shaped i depressions, evidently due to old embolic infarctions, the I general picture upon section being distorted. The intes-1 tines were distended and of a pale colour ; the bladder 1 was hypertrophied
... and the muscles were pale and exuded I little blood. 1 It is recognised in all hot countries that the back of the i neck immediately below the occiput is the important spot to be protected, both in man and beast, from the direct rays of the sun. These solar rays, I feel sure, act in the first place directly, and they do so by causing a disturbance in those vaso-motor centres which are situated in the medulla, affecting the proper discharge of their functions, and specially interfering with the action of the sympathetic system. The blood-vessels of the brain are enormously dilated, also those of the cord and the thoracic and abdominal organs; but those throughout the voluntary muscular system do not appear to be affected. The contracted pupils, absence of sweat, Cheyne-Stokes respiration, and hyperpyrexia, all primary symptoms, point to this conclusion. As suggested by Sambron, it is not impossible that a microbic influence is at work and the early appearance of lepto-meningitis would tend to give support to this theory. The essentials of treatment are ice, enemata, ice-baths, &c., and if a hose be handy it should be turned on to the patient for a time, as is done on board ship, in order to lower the surface temperature. A small dose of calomel should be given at the outset ; then, every hour, and afterwards less frequently, a draught such as this : 20 minims of solution of acetate of ammonium, 15 grains of bromide of potassium, and 20 minims of spirit of nitrous ether in water. I might be inclined in another severe case to try a hypodermic injection of pilocarpine to induce perspiration if I considered the heart would stand it. Then, to improve the flagging circulation, stimulants must be employed and, when the time comes, digitalis-not strychnine.