West Derby Union Hospital
E. Lister
1859
BMJ (Clinical Research Edition)
Surgeon to the Hospital. MARY ANN G., aged 30, was admitted into the above hospital, on April 5th, 1859, suffering from the effects of an over-dose of laudanum. For some time before, she had been in an unsettled state of mnind, and about half-past four o'clock on the above date, she sent a child to a neighbouling druggist for two shillings worth of laudanum; the whole of which she took about five o'clock. She then went up stairs, and was found some time afterwards lying on the floor in a state
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... f unconsciousness. A surgeon residing in the nieighbourhood was sent for at about half past seven or eight o'clock; and the stomachpump and emetics were used, no doubt, with some benefit. On my seeing her, however, in the hospital about nine o'clock, she was in a state of total insensibility; the pupils were firmly contracted, and the retina was quite insensible to the stimulu3 of a lighted candle; the breathing was laboured and stertorous; thie pulse slow and feeble; and all efforts to rouse her appeared useless. The stomach-purmp, emetics, strong liquor ammonhe and other stimulants, were used; the shoulders, back, palms of the hands, and soles of the feet, were flogged with wet towels; four powerful magnetic batteries were also brought into use, and applied to the spine and other sensitive parts of the body. The insensibility continued until about one o'clock A.I., when she gradually began to show signs of returning consciousness, and answered questions in monosyllables. Vomiting was occasionally excited, wlhich appeared to be of muclh benefit. She was then kept constantly moving about; but if allowed to rest, she would immediately return into a lethargic condition. At three o'clock, the sensibility had so far returned, that I considered slhe could be left with safety, giving strict injunctions to the nurses to keep her awake until I saw her again. She had a shower-bath given about nine o'clock, which had the effect of refreshing her considerably. On visiting her again at ten o'clock, she was much better; and on the following day was quite well. A constipated condlition of the bowels with headache were the only remaining symptoms. The druggist wlho supplied the laudanum stated that there were two fluidounces. The lhusbancl saw lher swallow it; but, bein, in a state of intoxication, he did not succeed in getting any part of it frolmi her, nor did he give any alarm, and she was aecidentally fotund by a wonian coming into the house two hours afterwards. The principal point in this case appears to be the length of time such a large quanitity of laudanium remained on the stomach, and recovery afterwards taking place; and I am of opinion that her life was saved by the continued use of the galvanic batteries. REMARKABLE CASE OF VARICELLA IN AN ADULT. By W. F. CLEVELAND, Esq. Mnis. T., aged 35, of fair complexion, highly excitable, had been suffering for about a week from slight gastric derangement, when she wvas seized in the middle of the day, May 21st, 1859, with shivering, which did not entirely leave her until she went to bed at niight. Next day she presented the usual symptoms of a smart febrile attack, witlh severe headache and drowsiness. As the bowels were rather confined, an alterative pill and black draught were prescribed; and, after this had acted, she was to take a saline &liaphoretic miiixture every four or six hours. There was now redness and slight fulness of the face. .May 23rd. ShLe complained of great itching about the chest and abdomeni, for which a lotion, composed of sulphiate of zinc dissolved in camphor miixture, was applied with benefit. There were now observed numerous small red protuberances on the skin. As the bowels had not been freely relieved, she was ordered to repeat the black draught. The same evening several vesicles, filled with white transparent lymph, appeared on the chest, abdomen, and face; and the opinion that the case was one of varicella was now given. The eruption was out freely on the scalp. May 24th. The eruption was much more copious, and consisted mostly of pustules. The eruption was now also on the tongue, gums, and lining membrane of the cheeks; also on the meatus auditorius externus of both ears. She complained of great pain in the ears and on each side of the neck. The eruptive fever was less. May 25th. The face was so swollen and disfigured, and there were so many pustules, that some doubt whether the case was not one of variola was felt. My friend, Dr. J. Ridge, was therefore requested to meet me in consultation; and after careful examination, he confirmed my view that the patient had an unusual attack of varicella. A saline draught was continued three times a day. The eruption was now out on the arms and legs; but only slightly in comparison with the face and body. The pustules outnumbered the vesicles. May 26th. Some of the pustules were beginning to shrink and pucker. Several on the face, chest, and abdomen, were confluent. I now counted the vesicles and pustules on the face, taking half of it at a time. On one side there were a hundred and twenty of these eruptive spots, and on the other side eighty. May 27th. There were some fresh vesicles on the arms and leas; but the eruption generally was beginning to scab. She complained of feeling very weak. She was ordered to take wine and beef-tea freely, and a fourth part of a mixture, containing sesquicarbonate of ammonia and chloric ether-, three times a day. June 21st. There are six or seven rather deep pits on the face wlhere the pustules were confluent. In all other respects she is quite recovered. She had been vaccinated in infancy, and the ordinary cicatrices were apparent. REMcARES. Chicken-pox is by no means common in the adult. Dr. Watson writes, " The disorder is almost peculiar to infants and children of tender years. Willan has, however, described one unambiguous example in a gentleman. thirty years old; and anotlher genuine instance was seen by Dr. Gregory at the Small-pox Hospital, in the person of an adult female." Some may entertain a doubt, as I did myself on the third day, whether the case was not one of modified small-pox (varioloid?); but when we regard the rapidity with which the pimples were converted into vesicles; the presence throug,chout the eruption of vesicles containing clear transparent lymph, which is said never to be the case in varioloid; the early period at which the pustules began to pucker and scab; the absence of the depressed centre so characteristic of the variolous vesicle; together with the entire absence of pain in the loins, and the disproportionate amount of constitutional disturbance prior to the development of such a copious eruption, as well as the subsequent progress and termination of the case, the evidence in favour of varicella seems to preponderate. It is generally laid down by authors that chicken-pox differs so greatly fromn small-pox in not attacking the face. Dr. Heberden is said never to have been able to count more than twelve eruptive spots ; but in the case I have detailed there were at the least two hundred. It may be men,tioned that at the time this case occurred small-pox prevailed in the neighbourhood; but I had not attended any cases myself, nor had this lady been in commllunication with anyone suffering from tlle disease. It mnay also be worthy of note that there had been an offensive smell from a drain for some weeks past in the room chiefly inhabited by my patienit, and as the temperature of the weather had increased, she was obliged to go into another house while the necessary repairs were progressing. It was just after removing into lodginigs that she was taken ill.
doi:10.1136/bmj.s4-1.139.692
fatcat:337b64434bgfbpgh5gigviyt4a