knee. On the 1st of June an oblique puncture with a lancet was made at the most prominent part of the abdomen, in the linea alba, six inches above the navel, and seven gallons and a half of coffee-colored fluid were evacuated. On the 8th a second puncture was made in the most prominent part on the left side, and four gallons and a half of a strawcolored ropy fluid were discharged. A puncture with a trocar was made on the left side on the 27th, and a gallon and a half of a very ropy brownish fluid was discharged. July the 6tli a small quantity of fluid was evacuated by the trocar, but a cyst of uncommon firmness closed the canula; this cyst was punctured with the trocar used for punc turing the bladder through the rectum, and three gallons and a half of ropy brown fluid were drawn off, completely emptying the abdomen.

After this last operation her health became much disordered, and she languished till the 6th of September, when she died.

On examining the body after death, the whole cavity of the abdomen appeared to be occupied by two large cysts formed in the left ovarium, of a firm texture. The upper of these cysts contained about two quarts of a brown glary fluid, the inferior about two gallons of purulent fluid; its inner surface was covered with coagulable lymph, laving in it many large dark-red spots. The right ovarium and uterus were in a perfectly healthy state.

The interesting particulars of this case were, the enormous quantity of fluid accumulated in these cysts, not less than seventeen gallons at one time; the little derangement in the health from extraordinary accumulation, almost the whole of the inconveniences she sustained arising from the excessive weight; and the inflammation and suppuration in the larger and inferior cyst, to which her death is to be ascribed.

It is a curious pathological fact, that in this cyst, "near a quarter of an inch in thickness, as compact in its texture as parchment, and entirely insensible, the process of inflammation should be excited, and go on to so large a collection of pus, attended with a rapid decay of the health, and showing the sympathy of the constitution with this adventitious substance, without pain or tenderness being excited in it, or the neighbouring parts."

Art. III. A Case of difficult Parturition, occasioned by a
Dropsical Ovarium forming a Tumor in the lower Part of
the Pelvis. By Samuel Merriman, M.D. &c.
Dr. Merriman was called to a woman in labour with her

second child; the process of parturition seemed to be retarded

V <g by by a tumor in the pelvis. On examination per vagimm, this tumor was ascertained to be soft and elastic, seemed capable of containing four or five ounces of fluid, was compressible, did not give the sensation of fluctuation, but rather felt as if it were a large pouch, formed by the coats of the rectum preternaturally distended. Beyond this tumor the child's head was felt within the os uteri, which was thick, rigid, and but little dilated. After thirty-six hours of ineffectual labour pains, it was deemed proper to have recourse to the perforator. After diminishing the size of the head, the child was expelled; and a second of smaller dimensions by the natural pains.

On the twenty-fifth day after delivery, the woman died of peritoneal inflammation.

"The body was opened the next day, and exhibited the usual nppearances of peritoneal inflammation. The left ovarium was in its proper situation, and of its usual size; but the right was found lying between the rectum and vagina, and had formed the tumor felt during labour. It was about the size of a small (rap-ball, and in a state of high inflammation. Il was divided into several cavities by membranous septa, which had a scirrhous feel, and was somewhat more than half filled with a fluid resenibling in color and consistence honey and water mixed together; it contained likewise a clot of blood. The pelvis was narrow, the diameter from the symphisis pubis to the sacrum being but little more than three inches."

The ingenious author observes on this, " that though the narrowness of the pelvis would have delayed the passage of the head through the upper aperture, it is not improbable that the presence of twins might likewise prevent the full effect of the pains." But he imagines that the position of the diseased ovarium, more than any thing else, prevented the expulsive efforts of the womb; not because it proved an obstacle to the birth of the child, but by paralysing all regular uterine^ction.

Several instances are adduced from authors, of tumors in the pelvis retarding the process of parturition.

Art. IV. Case of diseased Appendix Vermiformis. By John Parkinson, Esq. Surgeon. Inflammation and ulceration occurred, and through an opening in the appendix a fetid fluid escaped into the cavity of the abdomen.

Art. V. A Case of_ Diseased Testicle, accompanied with Disease of the Lungs and Brain, and terminating fatally. By Henry Earl, Esq. To which is added a Note, by William Lawrence, Esq. containing some Particulars of the Histories and Dissections of four Cases.

A boy, one year and nine months old, had, when a year

old, old, received a pinch on the testicle. From that period the gland gradually increased. He had been under the care of several surgeons; and leeches, poultices, mercurial ointment, &c. had been employed without producing any visible amendment. The case had been twice mistaken for hydrocele, and the testicle had been punctured with a trocar, but no fluid was evacuated. But little inflammation succeeded these operations, and the disease did not appear to be aggravated by them. At this period the testicle was rather larger than a goose-egg, and, when unsupported, reached to the internal condyle of the fenur. It was of an oval figure, with a regular smooth surface, and when pressed had an elastic feel, so as to produce the sensation of a fluid contained in a cyst; and so deceptive was this feel, that a 'gentleman, who has most extensive practice in the treatment of hydrocele, pronounced it to be that disease. It was not, however, in the slightest degree diaphanous; and, at the same time, was much heavier than a similar bulk of water. No testicle or epididymis at the posterior or inferior part of the tumor. The child had a most unhealthy aspect; the skin a greenish yellow, bedewed with a clammy moisture; the muscles flaccid, and diminished in size; head large, and prominent in front; eyes heavy; pupil dilated; and the iris of so unusually dark a color, as to be hardly distinguished from the pupil. Respiration rather laborious, troublesome cough, with frequent and hard pulse; abdomen tense, and habitually constipated.

The testicle was removed, the child regained health, and appearances were favorable for some months; but a disease in the brain and lungs, connected, as it does seem, with a peculiar morbid diathesis, which exists with this disease of the testicle, destroyed him. The dissection, previous history of the disease, and the subsequent remarks of Mr. Lawrence, illustrated by four additional cases, give considerable, interest to this paper.

Art. VI, Description of an improved Method of tying diseased Tonsils. By Thomas Chevalier, Esq. This method of passing a ligature round a diseased tonsil, cannot be made intelligible to our readers without the accompanying plate.

Art. VII. CaseqfCynancheLaryngea. Z??/j.r,farre,m.d. Something like novelty which attaches to cases of Cynanche Laryngea, the celebrity of some men who have fallen by it, and its fatal celerity, combine to give it importance. The two cases by Dr. Farre are of great interest, though

related Telated with much conciseness. The second of them, as having come immediately under his notice, we shall give in the author's words.

"A man, 60 years old, on the 31 st of March was affected with painful and difficult deglutition. April 1st, fluids attempted to be swallowed returned by nose; the tonsils were inflamed, and disposed to ulcerate. A brisk purge was ordered. At ten o'clock this evening, his respiration suddenly became difficult; thirty-two ounces of blood was drawn from his arm, whicli proved to be very sizy. At eleven o'clock, the tumefaction of the tonsils was inconsiderable; the deglutition was extremely painful, and very difficult; respiration was performed with convulsive and long-continued efforts; his voice was nearly inaudible, and he could only whisper. He answered inquiries respecting the seat of his suffering, by putting his finger on the superior part of the thyroid cartilage. He felt no pain in the chest All the muscles of respiration were thrown into violent action, and he lay with his mouth widely opened, pupils dilated, face pale and sunken, skin covered with a clammy sweat, his pulse 133 and smalt. His powers were prostrate, and general bleeding could not be repeated. The anterior part of his throat was covered with leeches, but the disease never paused. At midnight, bronchotoroy seemed to be the only resource; and soon after one o'clock its employment was decided on. About two o'clock Mr. Astley Cooper attended, and as suffocation was instantly impending, the operation was immediately performed, by dividing, laterally, the ligament which connects the thyroid with the cricoid cartilage. The dyspnosa was much relieved by the operation. He now lay passive, breathing by the natural and artificial aperture, and the inordinate action of the muscles of respiration had ceased. He swallowed some nourishment with a painful effort. In this state he passed the night, and the greater part of the following day. In the afternoon, the respiration by the natural passage entirely ceased, but was continued by the artificial aperture. He was now evidently sinking, and expired at six in the^evening."

At eight o'clock the next morning, the parts, as examined by Mr. Astley Cooper, gave the following appearances:

"The right tonsil inflamed and vesicated. The epiglottis swollen^ its edges meeting behind, exceptingjust at its upper part. Pharynx inflamed, somewhat vesicated, covered with coagulable lymph aboyt the epiglottis, but free from inflammation near its termination in the cesophagus. The aperture which had been made between the cartilages, appeared to be about the size of the glottis. The mucus membrane of the larynx and trachea was pale. There was some accumulation of mucus in the cells of the lungs, and a slight affusion of serum into their reticular texture."

The term Cynanche Laryngea is properly applied to this disease, Dr. Farre observes, because it proves fatal by constricting or actually closing the glottis, and constitutes precisely that case which, in its ultimate degree, imperiously demands the operation of bronchotomy.

Art. Art. VIII. History of a Case of Anesthesia. By

John Yelloly, M.D. This is a correctly written history of an unusual disease, and, as a collection of facts of a nature so singular as to confound soma of our physiological opinions on the action of the brain and neryes, deserves the serious attention of those who endeavor to explain the actions of those organs. The loss of sensation in the upper and lower extremities, independent of paralysis, at the same time that the integuments of these parts were more readily acted upon by certain external agents, (particularly vesication was produced by exposure to a degree of heat quite unequal to the production of it in a healthy skin) involve a contradiction not to be explained by any existing systems. Our limits do not permit an insertion of the case. Dr. Yelloly has annexed a collection of similar instances of Anaethesia found in authors.

Art. IX. Account of a Case of spontaneous Extravasation within the Theca Vertebralis. By Thomas ChevaLier, Esq.

This paper contains a short history of instances of extravasation of blood into the cavity of the spinal canal, constituting a species of apoplexy in which the brain is not directly concerned. It is conjectured to be produced by some violence ob extra, and is often rapidly fatal. Bleeding, and the antiphlogistic treatment very early employed, seems to afford the most rational means of obviating the impending danger.

Art. X. Observations on Diabetes Insipidus. By

John Bostock, M.D. Diabetes insipidus is considered, by Dr. Bostock, as of rare occurrence ;* and he believes this to be very decidedly proved by the fact of scarcely any distinctly detailed case pf this disease being recorded since the time of Willis, who first pointed out the sweetness of the urine. Cullen says (First Lines, 4, 85) that he had seen but one case in which the urine was not saccharine. The two cases related by Dr. Rollo, in which a large quantity of watery urine was evacuated, were consequent to a local injury of the kidney, and do not belong to this class. The case in Duncan's Annals (4801, p. 390—1802, p. SGl) is not entitled to the

* In the course of his remarks, however, Dr. Bostock seems, in no small degree, to have given up this opinion. At p. 114, he says. "for although cases of Diabetes insipidus have been but seldoni noticed, yet I am disposed to believe that it 1.- a more frequent occurrence than is generally imagined."

3 appellation

« ElőzőTovább »