Arthur Hassall
1852 The Lancet  
567 was certainly secondary to that of the ovary, since, on the 2ad, the womb was found healthy. CASE 3.-Sarah W—, a lymphatic girl, aged twenty-one, with light hair and blue eyes, tall and slender; has been living in London, as a servant, for the last four years. Menstruation appeared at seventeen, after suffering for a month from headache and great drowsiness. From the third month of its first appearance menstruation came on regularly. It assumed the monthly type, lasting four or five days,
more » ... d being in small quantity. Eight days before the last epoch, she was seized with intense pain in that portion of the left hypogastric region which corresponds to the ovary. Notwithstanding the pain, she did her accustomed work, and menstruation came on at the regular time, and as abundantly as usual. Unfortunately she was at that time obliged to go up and down stairs much more than usual; and far from being relieved by the catamenia, there remained an intense pain, which she compared to labour pains. She became hot, thirsty, and feverish at night, and she was admitted as a patient at the Paddington Free Dispensary on January 9th. I found the abdomen sore, particularly in the left ovarian region, where was also a sensation of fulness felt by the patient herself, and a slight swelling, which could not be detected on the right side. Walking or moving on the left leg, and pressure on the painful spot, increased the pain. There was no leucorrhoea, nor pain above the pubis. I ordered eight leeches to the seat of pain, and poultices to be afterwards applied over the leech-bites; but as the tongue was foul, and there was a tendency to sickness and constipation, I also ordered an emetic, and compound colocynth pills. The leech-bites bled freely; the vomiting seemed to relieve the intense pain, which was, on the contrary, exasperated by the purgative action of the pills; and when I saw her on the 13th, she was better in every respect, and the intense pain was circumscribed in the left ovarian region. There was no pain above the pubis, no leucorrheea, no external irritation. This intense pain produced by menstruation, so well limited to an organ we know to be highly congested at that time, unconnected with uterine disturbance, with peritonitis, what is it ? Those who attribute to the womb all acute disease of the genital apparatus, will say that the pain in the left ovary was the result of the uterine congestion determined by menstruation; and as, in the absence of marked uterine symptoms, I did not feel myself justified in making a speculum or even a digital examination, I could not object to the position, if, in similar cases, (Nos. 1, 4, 6, 9, & 10,) an examination had not been made, without any uterine disease being detected. Considering, therefore, the case to be one of subacute ovaritis, I followed up the previous treatment by the use of mercurial ointment, as in the former cases. 16th.—The patient was comparatively free from pain. 27th.—The ointment, pills, and mixture, were continued until menstruation came on at the usual time, and in the usual manner. After it was over, the pain in the left side had completely disappeared; but on considerable exertion, 01 pressure on the right ovarian region, the patient experienced the same kind of pain, only less intense. She was directed to continue the use of the ointment and poultice at night only; and on the 10th of February she was discharged cured. CASE 4.-Mary C-, aged twenty-two, looked like a Flemish girl, very stout, with a ruddy complexion, auburn hair, and blue eyes. She was admitted at the Paddington Free Dispensary, May 15, 1851. Menstruation had been easily established at sixteen, but had always been accompanied by a great deal of lumbo-abdominal neuralgia, appearing every month, or sometimes missing for two, six, or nine months without any considerable inconvenience. She had been very lately married. On interrogating the patient, I heard that when menstruating, three weeks ago, the flow, after lasting two days, had stopped for three, and then returned f01 one day. Its subsidence was followed by a violent pain in both ovarian regions whenever she moved about. It hurt her to pass water. There is considerable pain in the right breast slight leucorrhcea, and considerable fever. Any sudden movement of the lower limbs brings on the pains, so does ascending the stairs, and pressure on the ovarian regions, particularl3 on the right, which I found swollen and tense; a state oj things the patient expressed by saying ° she was all on one side." A digital examination convinced me that the woml was normal; the finger directed towards the ovaries greatly increased the pain, particularly on the right side, where a solid lump could be distinctly felt, while on the left side nothing similar could be distinguished, although pain was determined by pressure with the finger. The bowels were quite regular. I prescribed an antimonial mixture, and ten grains of Dover's powder at night, the compound mercurial ointment to be sprea l on the ovarian regions, and the application of linseedmeal poultices. 22n d.—The fever had abated, the pains in the back had disappeared, and those in the ovarian region were less intense. -The same treatment was continued. Menstruation returned at the third instead of at the fourth week, and had lasted its usual time, when, from standing for three hours, it returned as a flooding, and continued for several days. June 4th.—She was much better; pressure on the right side still, however, brings on pain and a sensation of numbness in the right limbs. In July the patient had menstruated regularly, and was free from pain. If this was not a case of sub-acute ovaritis, developed under the influence of matrimony in an excitable girl of a sanguine habit, what is the disease to be called ? The very abundant uterine discharge may have been considered critical in this instance, as it was followed by decided improvement. THE present and following articles have been prepared and written for upwards of a year. Their publication has been delayed to this time in consequence of numerous pressing engagements. Reddened litmus was employed in the foregoing experi. ments, in preference to turmeric paper, on account of the much greater delicacy of the indications afforded by it. We have now to take into consideration the results deducible from those experiments, and some of which are of an interesting and important character. 1st.—The simple act of boiling an aqueous solution of urea is sufficient to determine the gradual dissolution of that substance, and its conversion into carbonate of ammonia, a result at variance with statements made on this subject, particularly with that advanced by Dr. Bence Jones, and which was particularly adverted to in one of the former of these articles.* 2nd.—This conversion of urea takes place, after a time, in distilled water, even without the aid of the spirit-lamp, a result likewise opposed to a second statement made by Dr. Jones.t 3rd.-The decomposition of urea is effected, either with or without heat, much more readily in fluids which are alkaline, and especially in those the alkalinity of which arises from the presence of lime in any form. 4th.—The conversion of urea is retarded, and sometimes altogether prevented, by an acid condition of the fluid in which it is present; and this is equally the case, whether the solution be subjected to the heat of the spirit-lamp or not; the more acid the fluid, the greater its power of resisting the decomposition of the urea. 6th.—Animal matter in a state of decomposition exercises a powerful influence over the transformation of urea; and this it does by producing an alkaline condition of the fluid in which the two substances are contained, the alkalinity being produced by the carbonate of ammonia generated during putrefaction. It will be observed that this chemical explanation of the action of animal matter, in converting urea into carbonate of ammonia, is much more satisfactory than the vague and theoretical notion of Dumas, that the mucus of the bladder, by undergoing a putrescent change, acts, like yeast, as a ferment, and so aids the conversion of the urea. The alkalinity of urine very commonly proceeds from the presence of carbonate of ammonia, which is derived in part from the animal matter in that fluid, and in part from the urea; but the circumstances which originate, and either facilitate or retard this conversion, have not hitherto been well understood. We are now, however, in a position to furnish a tolerably accurate and complete account of what these circumstances are. It has been noticed that in some urines the urea disappears in the course of a few days, while in others it remains unchanged for weeks, months, and even * Animal Chemistry, p. 90. & d a g g e r ; Ibid.
doi:10.1016/s0140-6736(02)41272-x fatcat:m4vgzpvpwjbuvm6ssvx7tjfdte