Richard Lake
1895 The Lancet  
28 was surprised at the number of cadaveric alkaloids that had already been formed, and remarked upon the definite reactions which they gave out in the process of testing. In conclusion, the interesting features of this case are-(1) the difficulty in the diagnosis of the symptoms during life ; (2) the post-mortem birth of the child due probably to post-mortem contraction of the uterus, or to pressure of gases generated by putrefaction in the abdomen, or to both those causes together-no doubt
more » ... our had commenced previously to death ; (3) the well-marked laceration of the perineum ; (4) the inversion of the uterus ; and (5) the remarkably rapid putrefactive changes that had occurred. The fact of its having been a breech presentation seems to make this case even more remarkable. In giving evidence at the inquest I expressed an opinion—(1) that the symptoms observed during life did not correspond exactly with those of any known poison ; (2) that puerperal convulsions would be sufficient to account for death and probably caused it ; and (3) that it was possible for the child to have been expelled from the maternal passages after death if labour had commenced previously. A verdict was returned in accordance with the medical evidence. Chesterfield. Suc6 a case as the following, which has recently occurred in my hospital practice, is sufficiently rare to be worthy of record in the columns of THE LANCET. A girl two years of age was admitted into the East London Hospital for Children on Nov. 22nd, 1894, with well-marked jaundice of skin and conjunctivae. She was said to have been always weakly and to have had pneumonia a year previously, but no other definite illness. Her family history was good. Her illness began three weeks before admission with a "cold." The child had a cough and was constipated and sleepy; the appetite failed, but there was no coryza. Jaundice was noticed two weeks before admission; the motions were white and the urine was of deep colour, staining linen. She vomited four days before admission and was restless at night, throwing herself about. On admission jaundice was found to be well marked, and the child appeared to be very ill and rather restless. The lips were of good colour. There was no cough and the temperature was normal. Nothing abnormal was revealed by physical examination of the heart and lungs. The liver was felt one finger's breadth below the costal margin, somewhat hard and smooth. The upper limit of dulness was perhaps a little lowered. No other abnormality could be detected anywhere. She passed a fairly quiet night on the 22nd, though she was somewhat restless. About ten o'clock on the morning of the 23rd she became very restless, and soon after grew apparently unconscious of her surroundings. Delirium set in, soon developing a maniacal character, the child throwing herself about in bed and biting her clothes and hands or anything she could reach with her mouth. The pupils were equal and rather contracted, but reacted to light. The pulse was 120, irregular ; the temperature was still normal. The urine and fseces were passed unconsciously. The jaundice had increased in intensity. The child was very thirsty. Petechiæ now appeared on the front of the legs. The child cried very little, but moaned when disturbed ; the tongue was covered with a dirty white fur. The patient remained maniacal all day, but during the evening became quieter and drowsy ; the pupils were dilated and sluggish at 10 P.M.; the temperature was 100° F. ; the pulse was 140 regular. During the night coma gradually set in, the petechiæ became more numerous, and the jaundice more intense. About 5 A.M. on the 24th the child vomited a quantity of blood and died shortly afterwards.
doi:10.1016/s0140-6736(02)06372-9 fatcat:7w52bdjup5ervibqgx76wlte7q