MIDDLESEX HOSPITAL

Hall Davis
1882 The Lancet  
436 going to drown herself, while she was all the time confined to her bed. " Felt as if she had a wheel going in her right shoulder." In this case the mental disturbance (which lasted some three or four weeks) was evidently due to the disorder in the reproductive organs ; and the abnormal sensation was produced through the medium of the ganglionic nerve, from the sacral to the middle cervical plexus, iuvolving in its course the semilunar ganglion, and by necessity the special organs of
more » ... l organs of nutrition. (To be concluded.) OF Nulla autem est alia pro certo noscendivia, nisi quamplurimas et morborum 'et dissectionum historias, turn aliorum turn proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Caus. Morb.,lib. iv. Procemium. FOR the notes of the following case we are indebted to Mr. McCausland, resident obstetric assistant. M. W-, aged twenty-five, murried two years and a half, was admitted into Prudhoe ward Nov. 3rd, 1881. The family history showed no morbid tendency, Ten months after marriage her first and only child was born at term, and living; she suckled it for twelve months; the catamenia then reappeared once, and normally. In June, 1881, slight hæmorrhage occurred from the uterus; three weeks later, while in bed, an abortion at four months and a half set in with considerable haemorrhage, for which the medical attendant removed the fcetns, which came away entire in its membranes. From that time haemorrhage had continued more or less, at times in an alarming degree. In October the patient was treated in a special hospital, and something, she believed, was removed, but the haemorrhage recurring after she left the hospital, she applied for admission into Middlesex Hospital. On admission she was a spare woman of somewhat fair complexion, very weak, with pallid face, and excessively anaemic lips and gums; the tongue was pate and flabby, Temperature 97.4°; pulse 140, small and weak. There were constant nausea, severe headache ; slight blood-stained discharge issued from the uterus. The vagina was pallid and relaxed ; the uterus was movable and in good position ; the external os uteri was patulous, the anterior lip being red and excoriated. On applying the taxis to the wall of the uterus in front of the cervix, a dense tissue could be felt through. The patient was so weak that ic was not judged prudent then to submit her to operative tte,-.tment, especially as there was no actual hæmorrhage. Citrate of iron was given thrice daily after, and pepsin before fo.'d ; beef jelly, and subsequently chicken also, comprised her diet. A" the irritability of her stomach subsided her strength improved. On November 19ch acid 21st and December 2nd she had recurrences of haemorrhage, which were severally arrested at once by vaginal plugging, also by subcutaneous injections of ergotine and by gallic acid. On December 3th tents were employed to dilate the os, so the point of the tinger could ba passed within to examine the internal condition of the uterus, when a growth with an irregular surface could be felt attached to the anterior wall of the uterus It was thought better, however, as there was no hæmorrhage present, and the patient was very weak, to wait for further rallying of strength before resorting to -operative interference. On the 8rh the dilatttion, having been maintained, was completed under anæsthesia—a mixture of chloroform and ether being adiiiinistered-and the growth was remove 1 by torsion, as it was not of a shape to admit of the application of the écraseur wire. A small part of the growth was so identified with the uterine wall, that it had to be left. The uterus was injected with cold water, and swabbed out with perchloride of iron. Only slight hæmorrhage attended the operation, and none followed it. Ou the 9'h the temperature was 105'4° ; headache and rigors occurred. This condition was treated by quinine and a light nourishing diet ; cooling applications were made to the head, and the uterus was washed out with Condy's fluid from time to time, some offensive membranous flakes being discharged. The temperature now gradually fell, so that on the 20th it was 98 2°. At the end of the month the patient complained of pain in the lower lumbar and sacral regions, although otherwise she was much improved, and had had no recurrence of hsemorrhage. A re-examination was made, aud discovered retroflexion of the uterus. This was treated by a Hodge's lever pessary, its upper end being adjusted behind the neck of the uterus.
doi:10.1016/s0140-6736(02)26330-8 fatcat:7qlf5ngyxney5g4ft7cxiv2odu