ANSWER TO THE REMARKS OF A WRITER IN THE "MEDICAL GAZETTE"

1844 The Lancet  
529 there was no tumour to be felt, and that which was shown me was, undoubtedly, the polypus which I had felt upon my first visit. For the following case I am indebted to my talented friend, Mr. Jarvis : — About ten years ago I was attending a Mrs. H. in Wigmore-street, when a friend of hers arrived from the country for the purpose of having a large polypus tied by Mr. Stone. She was very much reduced by loss of blood, and had evidently suffered extremely from the great demand that had been
more » ... nd that had been made upon her. Notwithstanding she felt that her life was draining from her, she determined to wait a few days before she submitted to the operation, hoping that the rest would enable her to bear it better. Three or four days after she was surprised to find that the discharge had entirely ceased, and she continued perfectly free from it for about three weeks. At the end of this time a slight fetid discharge came on, which alarmed her greatly, but on examination it was found to arise from the polypus lodging in the vagina, having separated from the uterus apparently from ulceration of its slender pedicle. CASE 2.-Dr. Gooch has related the following cast : -" Dr. Babington took me into the country one evening with my instrument to remove a small polypus about the size of a walnut, which he had discovered in a lady the day before. He had described the case to me about a week before, when I advised him to examine the uterus, and said I thought he would find a polypus. She was about fifty-five years of age, and for a year and half had been subject to frequent haemorrhages from the uterus, without pain. We found her in bed ready for the operation. The polypus was so small that I took it between my fingers and drew it downwards, on which the stalk broke, and the little polypus came away. Dr. Babington on examining it immediately afterwards was surprised to find no polypus, upon which I showed it him in my hand." -P. 288. CASE 3.--About two years ago I was requested by my friend, Mr. Jackson, to accompany him to a patient who was in great danger from uterine haemorrhage. We found her lying in bed exceedingly pale, restless, vomiting, and her pulse was very frequent and scarcely perceptible ; from the appearance of the bed and floor alone, it was evident she had lost an immense quantity of blood, which was still issuing from the vagina ; the tumour was of the size of the head of a new-born infant, attached by a pedicle as thick as its neck, and it protruded externally. It was attached to the anterior lip of the os uteri, of which part it seemed a prolongation and enlargement, and it was with great difficulty that I could reach the uterine orifice. A ligature of whip-cord was applied upon the pedicle, by means of Dr. Gooch's instrument, and on the third day, as the stench from the tumour greatly distressed the patient, it was thought right to remove it with a scalpel, by an incision below the ligature. She recovered without an untoward symptom. This patient, previous to the protrusion of this enormous tumour, which was sudden, had only complained for a few months of a slight increase of the catamenial discharge, and the gentleman whom she had consulted before she saw Mr. Jackson thought it unnecessary to make an examination. of intemperate habits, aetat. 45, was riding on the shaft of his team, when he fell, and the wheel passed over both his thiglis. On his admission to the Croydon Infirmary the left femur was found to be fractured about two inches from the patella: the wheel had passed over the opposite thigh, at about the same place, without doing more apparent mischief than a slight abrasion of the surface, and producing the next day a little ecchymosis around the spot; he complained of pain, which was relieved by the lead lotion. The fractured femur was put up with Mr. Bottomley's 'Improved form of Liston"s long splint,* and was doing' well. Nothing was required for the other thigh, and the man was considered out of danger, when on Sunday, at eleven, a.m., four weeks after the accident, I was called to see him in great haste, as the sound leg had turned quite black. I found the leg and thigh presenting a livid appearance; the veins swollen and prominent; the surface of the limb cold and tender on pressure; the patient was in a state of collapse, and covered with a clammy sweat; the pulse quick and very feeble: great anxiety and intense pain. The part where the bruise had formerly been was rather darker than the rest, and the man stated that he was first seized with pain at about five in the morning, but had not complained until several hours after. Warm poppy-fomentations were applied to the leg, effervescing medicine, with brandy, opium, and ammonia, were given freely, and calomel and opium every two hours. Obstinate vomiting now came on, all the medicines were rejected, and creosote and hydrocyanic acid were given, but without effect. He then took twenty grains of Dover's powder, which checked the sickness. In the afternoon the lividity had extended as high as the right breast, the pulse was scarcely perceptible, and a fatal termination appeared inevitable. The tongue was dry and coated, the bowels relaxed, delirium of a low character, set in, and all the symptoms of a poison circulating in the system were evident. He remained in an insensible state until five the next morning, when he died. A post-mortem was not allowed by the family. After death the part that had been bruised appeared more livid than the rest of the limb. The other leg and the body presented no unnatural appearance. The diagnosis of this case, at first sight, was rather obscure, as there was no apparent cause to which the sudden attack could be traced; but the rapid and fatal termination, the local and general symptoms, could not have belonged to any other disease. Might not a post-mortem have revealed the causes? Could any injury to the muscles, or coats of the vein, have laid dormant for four weeks, and then broke out in that malignant form so suddenly, without any exciting cause.
doi:10.1016/s0140-6736(02)73308-4 fatcat:i2bl36xzqng5tdodbj4ptbvile