British Medical Journals

1848 The Lancet  
of Dalston, was attended by the author in April last, in her first confinement. She had a quick labour, and bore an average-sized male child. A few minutes after the birth, his attention was directed to the following appearance by the nurse°.-An open wound extended from the third dorsal vertebra, across the scapula, along the back part of the humerus, to within an inch of the elbow. The existing condition of the wound at the time of birth was illustrated by a drawing, which showed that a
more » ... howed that a considerable portion of the I wound was already healed,-a part of the cicatrix seeming to indicate that there had been ulceration of the edges of the wound prior to the healing by granulation. The edges of the wound were jagged, and at the spinal termination appeared bifurcated. In speculating upon the probable causes of this singular injury, the author classes his queries under four heads-viz., Could a blow produce it ? Was it the filinis ? Was it by a sudden and violent contraction of the uterus ? or, lastly, may it not be ascribed to an accident which the mother had about six weeks before delivery ? The author considers that he is justified in concluding that the last 3nentioned was the efficient cause-The nature of the accident was this. The patient was running down stairs in a hurry, when she trod upon a cat, and to save herself, made a spring of five or six steps at once, alighting on her feet. This was succeeded by faintness at the time, and a sanguinous discharge from the vagina on the following day, which, however, soon disappeared. The, author states that this large wound was quite healed at the expiration of five weeks; and concludes his paper by directing attention to the importance of the case in a medico-legal point of view. British Medical Journals. The following interesting case has been recorded by Dr. i CopBMAN in the Provincial Jo2vrnal:-' "CASE OF ACUTE HYDROCEPHALUS-IODINE-CURE. " W. M—, aged six years, of scrofulous habit, well but delicately formed, of quick perception and excellent memory, with a remarkable fondness for reading and study, has almost from birth been subject to slight convulsive actions, starting during sleep, and awaking with a scream, but in other respects had enjoyed good health until about the beginning of April, 1847, when he began to lose his appetite, his bowels became deranged, and his sleep more troubled. On the 18th he was attacked with violent purging, which, however, soon ceased, but he became very restless and feverish, and complained of pain and heaviness in the head. For several nights, and frequently in the course of the night, unless constantly watched, he jumped completely out of bed, screaming violently. A purge of hydrag. cum creta and scammony was given, and acted freely, cold was applied to the head, he was put into a hip-bath, and ordered to take small doses of calomel and antimony, and a mixture of acetate of ammonia. "This treatment was continued for ten days, but his appetite failed, and he became stupid, sitting for hours with his chin upon his breast, and not answering questions unless previously roused by a loud noise, or by shaking him, when he started and appeared frightened, but answered collectedly, although very briefly, and in a peevish tone. He complained of no pain, and was not feverish. Pulse very small and frequent; tongue covered with white fur, but moist. Blisters were applied behind the ears, and at the back of the neck, the calomel and antimony continued, and, as he took no food, and appeared very feeble, a mixture of bark and ammonia was prescribed. The bowels being costive, aperients were from time to time given. " About the 29th, he began to complain that he could not see distinctly, and at the same time his speech became very difficult, so that he could hardly be understood, and his hearing was also greatly affected. In a few days he became quite deaf, to all appearance blind, and when he attempted to speak" which was very seldom, he could not be at all understood. The pupils were widely dilated, and the pulse hardly to be felt at the wrist. While in this state, (about May 2nd,) he was ordered five drops of Lugol's solution of iodine every four hours: two days afterwards he became more sensible, could hear a loud noise, and took food. The iodine was continued, the dose being gradually increased; and he recovered, by degrees, the senses of which he had been deprived, being in better health at the beginning of June than before the attack. " He has remained in good health up to the present time,. September, 1848." "PECULIAR OBSTRUCTION OF THE BOWELS. I " Dr. DoNOVAN states that he has recently met several cases of this disease, which is an obstruction of the bowels, occasioned by a large mass filling up the rectum, and incapable of being passed through the anus by the ordinary process of defecation. "He attributes the obstruction to the use of diseased potatoes, and states that he has met with several cases. In four which occurred in one week, in dispensary practice, he found in all the symptoms alike, and gives the history of one, as an example:-" Patrick Happlied at the Skibbereen Dispensary. He was then labouring under severe tenesmus and bearingdown pain, and. to use his own words,'had a bowel complaint on him for four days, and could pass nothing but red blood.' He further stated that he could make no water, and that there was a lump in his seat.' " This description of his disease, and the fact that my attention had been directed to the subject by a friend, Dr. Fitzgibbon, who detailed the particulars of two similar cases that occurred in his practice a few days before, led him to make an examination, and he discovered, at the orifice of the gut, a large solid mass. The parts around the anus were puffed out, and the sphincter was distended to the utmost. " It was evident that mechanical means could alone relieve the sufferer, and on using the handle of a pewter spoon for the purpose, a large quantity of consolidated potato-skins, with some portion of the substance of the tubers, and coarse Indian meal, was dislodged. The retention of urine was immediately removed, and the other symptoms relieved, but recurred, and required for four successive days the same treatment, together with the administration of large enemata of warm water, which assisted in bringing down and breaking up the firm mass that filled the intestine. " These concretions were almost entirely formed of potatoskins, and were consequent on the use of diseased tubers, in which the peel and farinaceous substance of the potato are so intimately blended together, that it is impossible to detach the former in the ordinary way, and large quantities of the skins are consequently swallowed, and, accumulating in the bowels, form the obstructing masses described." Dr. Donovan remarks,-.-
doi:10.1016/s0140-6736(02)73007-9 fatcat:g3e4dzbjhbbbnfq67s2lv2rpdq