Reports on Medical and Surgical Practice in the Hospitals and Asylums of the British Empire

1900 BMJ (Clinical Research Edition)  
rMAH 31, 1900. which amputation below the knee was the only remedy. My friend the late Dr. Phillips drove a distance of thirteen miles to assist me in the operation. Soon after commencing to give chloroform he removed the lint from the woman's face, and whispered in my ear that her heart had failed. The woman was apparently dead, but after doing all we could in the way of restoration, we were relieved to see her return to life, and in half an hour she was herself again. On informing my patient
more » ... hat the operation could not be proceeded with, and why, she calmly said, " Please cut it off, doctor; I can stand it without chloroform." This staggered me a bit, but after a brief consultation we replaced the tourniquet, and I went to work as rapidly as I could. In a short time (not within the minute) the leg was removed, and the stump bandaged, etc. During the operation the womain reinained perfectly still, no resistance (not even a groan) escaped her lips; she lay with her eyes open apparently watching every step of the operation. When it was all over, on asking her if she had suffered much pain, she replied, " Hi! I no flesh and blood? Course it hurt me." I then asked what part of the operation was most painful, and she told me that stitching up the flesh (as she called it) hurt her most. The late Sir Bryan Edwards, many years ago Chief Justice of Jamaica, who had been a midshipman in the navy before the days of chloroform, told me how he had one of his fingers amputated when on board one of His Majesty's frigates. He was made to sit down near a table and deliver his wrist to the tight and strong grasp of a stout dresser, while the assistant surgeon cut the wounded finger off. Robert Liston would have managed it better. My old friend told me that the pain was like the prolonged extraction of a tight jaw tooth, because it took so much time. He described the taking up of the arteries as exeruciating. Monathie, Jamaica. JASPER CARGILL, L.R.C.P.Lond. A CASE OF "SPURIOUS HERMAPHRODITISM." J. C., aged 20, a domestic servant, was sent to me because of not havingf menstruated. She had felt no discomfort, nor any sensation whatever, such as she had been told to expect at the onset of the periods. She was, to look at, a rather tall fair girl, with a pleasant feminine voice, and indeed nothing external to point to the existence of anything unusual. On examination she was found to have no breasts, the pelvis was female in type, the pubic hair arranged as in women, but there was absence of fat over the trochanters. In the right labium majus there was a small ovoid body with the " feel" of a testicle, and which on pressure gave peculiar sensation. This was suspended by a cord, which when traced upwards disappeared into the inguinal canal of the right side. The clitoris was not enlarged, and the urethra was normal and feminine in arrangement. A well-marked hymen was present. The vagina was small, but admitted an ordinary sound easily, and the sound could be passed for about 2' inches. With the finger in the rectum anid the sound in the vagina there could be made out the absence of anything beyond this small vagina -no uterus, no appendages. Summing up the conditions, there were on the one hand: (a) Absence of breasts. (b) Absence of fat over trochanters. (c) Absence of uterus and appendages, unless the body in the right lab um majus were to be considered an ovary. (d) The presence of a body in the right labium majus, if considered a testicle. On the other hand, there were: (a) Feminine voice, hair arrangements, and "feelings" (patient had been keeping company with a young man. and had lived with female domestic servants and slept with them without exhibiting any marked partiality for their society). (b) The presence of a clitoris, urethra, vagina, with hymen. (c) The pelvis had female dimensions. (d) Presence of a body in the right lablum majus=an ovary. Dr. Champneys, who also saw the case, was of opinion that it was that of a girl with an ill-developed ovary which had " prolapsed." The patient was advised as to her state being peculiar, that she would never be able to marry, and was asked to appear again if the body in the labium began to swell or gave any trouble. Medical Officer.) A. L., a nurse in this asylum (stated to be phthisical), aged 27, single, complained of fever with a rash and sore throat on November 2gth, I899. The rash was distinctly of three types: (i) Small scattered areas of tiny papular elevations chiefly over forearms and legs; (2) a few sudaminal vesicles; and (3) aX characteristic hyperaemic rash over the sides of the face and neck, and the front of the chest. There was a history of vomiting. The circum-oral pallor was distinct, and the tongue was furred, but not characteristic. There was a moderate soreness of the throat. The temperature was only 102 20 F. Scarlet fever was diagnosed from the local appearances and the history of infection, and the patient was isolated in a special hospital under my care. The following night she was delirious and violent, and it took two nurses most of their time to keep her in bed. The next day I gave her morphine acetate gr. -and trional gr. xvi, and she slept well. The temperature also fell to IOI.60 F. The following night she slept without the aid of any drug, but on December 4th she was given morphine acetate gr. 2. The urine was examined daily for albumen" and on December sth there was a fair quantity, but curiously enough it was entirely ab3ent the next day, and till her discharge she had no further recurrence of albuminuria. The ears, chest, and palms of hands desquamated slightly ; the legs and feet not at all. She was kept absolutely on milk till December 7th, when her temperature reached normal. Her diet was then altered to beef tea, eggs and brandy being allowed. The temperature, unfortunately, again rose slightly in the evenings, and she developed slight pleurisy on the left side on December x8th, which soon yielded to treatment.
doi:10.1136/bmj.1.2048.762 fatcat:54ljt3elorcuhigdj7nz3xm7em