ON THE CASE OF POISONING BY ACONITE, AND THE INQUEST AT THE CONVENT OF THE GOOD SHEPHERD

J. O'Bryen
1853 BMJ (Clinical Research Edition)  
AND Al'OPLECTIC EFFUSION, OCCURRING IN A FCETUS IN lTERO. IN the Deutsche Klinik for November 27th, Dr. C. HiiTER, of Marburg, after refering to several authors who have written on the subject of intra-uterine inflammation occurring in the fantus, relates the following case, which we abridge. CAsE. U. M1. H., aged 28, of small, weak conformation, was delivered, oct March 28, 1852, after a tolerably easy labour, of a fenmule child, apparently of the full period. It was apparently dead; but
more » ... tly dead; but gisped several timies while attempts to resuscitate it were cariedt oni. These attemupts, however, proved quite unsucs,essful. Post mortem Examination. Munch blood escaped. on making an incision iilto the back, and also from the vertebral canal. B3eneatli the diima mater, in the neighbourhood of the cauda equinia, there was a clot of the size of a pea, and a larger one near the foramen miiagnum. The medtulla oblongata was stirrounded by coagula. A quantity of blood flowed froni the vessels of the arachnoid, especially near the canda equina. Between the skin anid the galea aponeurotica, the wlhole skull, as far is the clheeks, was covere(d with a gelatinouseffusion, here andl there containing extravasated blood; anid there was a general excess of blood in these parts. The cerebellum was surrominded with coagrulated blood; and between it and the tenitoriunIi), were numiieroubs snmall clots: blood was also extravasate(d in tlhe tentoniunt itself. Within the cerebellu m, there were six cogulda, eacch of the size of a pea. Tlhe cerebrum wias also very f'tll ofllood, and(I contained; several extravasations. On thje right side of the longitudinal sinulls, there iwas a coagulum. in the torna of a leech. In thie right (choroid plexus, a varicose vessel wias founzid. In the vicinity of the lateral ventlicles, there wvas so mnicih blood effused, that the cerebral mass could not be distinguisislc(l. On t)peniniu the chest, niuch gelatinouts exuldation wans found untler the skin ; but there wras nto serunm in thte pleura'-. The thoracic viscera, taken together, swamn in water; the tight lung swam in water, the lower lobe ten(ling to sinik; the left luilig sank to the hiottnni of the vessel. T'hie bronchial tubes in the righit lung vielded. siome frotlhy niueus on pressure; those of the left less. 'Thle ptiper lobe of the right lung was firmn to tlle touch, crelitated oni incision, andz ieldle(d greyish frol)thy msatter, buit little blood: whien it was incisted uniider water, smnli bubbles of air escaped. The lower lobe was tirm, crepitated less, biut yieldled frothy muiicus on pressure. On section, wlhite firm spots were fouind in this lung. 'The left lung felt hinter, andil knotty, ain( was mostly non-crepitant. In the viciiity of the lower suiirace of the ipper lobe, and the upI)per part of the lower lobe, it crepitated a little, and contained a little air. There was not anly increased quantity of fluiid in the pericardiinm. 'The cavities oif the lheart containel firmnly coagulated. blood, which extendledl into all the openiings, even through the foranmen ovale, an(l adlered firmly to the walls of the organ. Sonie of tih trahecilhr in the right side of the heart were of a yellowish gi y colour, and lhad. On cuitting through the septum, it was foind to have (legenerated into a yellow hartl mass, from>llaloijt three lines from the apex as far as the aulrieles, for a breadth of thirece or four lines. In the ntidst of this degenerate(l portion wst fouind a caity the size of a pea, from whichl purulent fluid es-caped on incision; and utenrer the apex there wias a smaller cavity. On miicroscopic examination, pus Ccorpuiscles were observed. BRettween the albdominal miuseles and the abdonmen, were foumd gelatinous nmasses. The umbilical vessels contained no blood. The intestines were glued to each other, aind to the peritoneulm, by plastic exidatioii. T'lhe peritoneal cavity contained a large quiantity of serum. The large intestine was thickened, and contained mnuch imieenium. The sniall intestines contained thinl, mucls-like masses. Tbe mucous membrane was easily separated. The liver and spleen were very sangnineous. The right Fallopian tule was cemented by exuidation matter with the small intestines, hjut was not itself inflamed. The muscles of the limbs were pale. The mother was discharged well on the 8th April. TO THE EDITOR. Srn,-As few complete cases of poisonaing by tincture of aconite are on record, may I beg insertion in the ASSOCIATION JOURNiAL of the following remarks, in addition to, and in explanation of, the account of the inquest which appeared in the number of last Friday, p. 71. The conduct of the jury antl of the coroner w.re so unusual as to clam attention from the profession. I was requested, on the 5th of this month, to visit some patients at .Axno's Court, near Bristol, an esstablishment for the reformation of unfortunate females. Two were suffering from severe neuralgia of the face, and one (the individual whose case I am about to describe) comllainled of tape-worm, with wlhich she had been afflicted for some years. I ordered her to take oxie dmrachm of the bark oif the root of pomegranate, and one grain of (Iiuinine in water, every morning, fasting; and, after a week, to take half an ounce each of spirit of turpentine and castor oil, also in the morning. I directed for the other two proper diet, a nmild aperient, and thirty drops of the following emibroeation, to be applied externally over the seat of pain:-Tinct. aconiti (Flem.) 3ss; acet. morphiw gr. iv.; to be miarked. "The embrocation for external use only; a piece of linen, the size of hlalf a crown, to be wetted witlh thirty drops, and applied over the seat of pain, covered with oil-silk, antil a bandage." Unfortuinately, at 7i o'clock, A.31., on the 10th inst., the pomegranate being prepared in water, and placed in a bottle niext to the embrocation, the lady wlho undertook to administer it, pouired, by mistake, rather mlore thani a teaspoonful of tlhe mnibrovation into a clip, and tlhen half filled it witlh water, andl gave it to E. Forty; wloL drank it at oince, and( in a iew minutes lievanie very thirsty, and complained of a great burning and pain in her stomach and thlroat, an(d (dranlk two tumblers of cold( water, and( in fifteen minutes beg,an to vomit violently, which she eontinuiedi to (10 for two hours. At first, she stood utp to vomnit; on a second attempt, slhe fell back in the arms of an attendlant, helpless as if dead. Slhe was very restless; the pain in the epigastric region increased. Alter tiie first hour, slhe was unable to (to more titan turni hier neck anti lhead a little, and to vomit. She now had tenesmus; andt coiivulsive movements of the miuscles. At nine o'clock, she begani to look stup)id, complained of vertigo, and wast covered with coldl sweats. At ten o'clock slhe was quiet as if asleep; at a qluarter to ele%en she was still consciousx, repliedl to questionis, anid said,1" Lord, lhave mercy on me"; she then apparently wenit tO slee), antld was niot discovered to be dead until half-pnst eleveii o'clock, A.M. ThJere weere no general convulsions 4ibser-ved. Paini in the epig;astric region was very marked up to the last. Jan. 14th. My friendl Mr. P'riehard, made the post mortem examinationi with me. We foiund the face looliinig swollen anld dark-coloured, as well as the Iips; tiie miiuscular system rigid; the pupils rather (ilated; the eyes very bright. The expression of the cotuItteinanic was that of a personi wlo lad died a siolent death. Trie memlbranes (if thel brain were con,ested, buit the brain itself finn anld healthy. The lunjgs were also healthy, nitl some post ortem congestion from gravitation; when the thtorax was opened, they (lid not fill the cavity. The leart was ilaecid, and the walls of the ventricles were ratler thin. The uterits was atliereongested; the bladderempty; the sphincter ani was relaxed, and the anuis very open. The stonaclh contained some mulcus, and the membrane lining the large curvature was injected in patches, but otherwise natural. The abdomen contained thickened mucuns, anld the mueous membrane was in a I i fh state of inflammiation, abra(ledl in patches; the membrane being in them dissolved anid broken (down. There were many spots of a very dark colour. The small intestines contained a large tape-worm, many yards long. As I did not see the patient whilst suffering under the effects of the aconite, I have collated these symptoms from the very imperfect information of non-medical persons: pain in epigastric region, thirst, vomiting, -vertigo, muscular prostration (as evidenced by her inability to stand), cold sweats, irregular convulsive movements of the muscles, some stupor of the countenance two hours after the dose was swallowed; in three hours, apparent sleep, but consciousness and speech to within half an hour of death. The state of the abdoaQn shows well the
doi:10.1136/bmj.s3-1.4.92 fatcat:o3y45gphgnd53ckujr54lchiey