BY RICHARD H. THOMAS, M. D., OF BALTIMORE. Case, in which it was believed that twenty grains of Arsenic had been taken, relieved by the Hydrated Peroxide of Iron, administered six hours after the poison was swallowed. Baltimore, 7th mo. 4, 1838. 6th mo. 1st, 1838, 83 A. M., I saw Samuel Biddle, a robust man, about forty years of age, who told me that at 3 o'clock that morning he had mixed a powder in dry sugar and swallowed it for calomel; he left home immediately for his place of work, and whilst walking along-say in about fifteen minutes was seized with a peculiar burning pain in his stomach, which induced him to believe that he had taken arsenic instead of calomel, as he remembered that he had in his chest two papers-one of twenty grains of arsenic, the other twenty grains of calomel. His suspicions were confirmed upon reaching his lodgings, when he found the paper of calomel properly labeled. This he took at once in a little dry sugar, and waited until daylight before he sent for me. He has had violent colic pains; some cramps in the lower extremities; no vomiting or purging. There is now a burning pain in the stomach; a tender epigastrium; white tongue, and corded pulse. I felt at first inclined to think he had been mistaken, and that he was labouring under gastritis. I bled him and ordered a sinapism. Upon questioning him more closely, and the symptoms increasing, I thought it would be safest to treat him as if the facts were ascertained. In half an hour, by the kindness of my friend, Professor Fisher, of the University of Maryland, I was enabled to give him the hydrated peroxide of iron. Dr. Fisher saw him with me at 9 o'clock, all the symptoms had increased; thirst, burning pain; epigastrium exquisitely tender. We gave him half a fluid ounce of the hydrate, which was in the wet state, and about the consistence of thick cream, in a tumbler of cool water, and directed the dose to be repeated every ten or fifteen minutes, in two ounces of water. A large dose of magnesia was also given, to be repeated in two hours. 12 A. M. The pain and burning in the stomach are much lessened-seem transferred to the bowels, which are tender to pressure. Continue the medicines. 4 P. M. Much relieved in every respect; has had several large evacuations from the bowels. 7 P. M. Still better; bowels freely purged; has swallowed eight ounces of the suspended hydrate, and three or four doses of magnesia. Next morning, though weak, he seemed to be free from disease, and next day sat up, and had no bad symptom afterward. Such is the case as it occurred; whether it be a fair test of the virtues of the peroxide as an antidote for arsenic, I leave the reader to judge. The VOL. II.-8. patient is a respectable man, and entitled to credit; he is positive as to the facts. The length of time-six hours-before any very severe symptoms supervened, and before the antidote was administered, at first caused me to think that he might himself have been deceived. Professor Von Specz, of Vienna, however, asserts, "That a dram of arsenic in powder does not produce its deadly effects on the system in less than six or eight hours, while the same quantity dissolved in warm water destroys life in a much shorter time." In the present instance, it was swallowed in a dry state, covered with sugar. The prompt relief which followed the exhibition of the peroxide is also confirmatory of the impression that the poison was really taken. ART. II.-PHILADELPHIA HOSPITAL (BLOCKLEY). CLINIQUE OF DR. DUNGLISON. 1.-Case of Scrophulosis-Morbus Brightii, General Dropsy. Reported by ALEXANDER M. VEDDER, A. M., of New York, Senior Resident Physician. Mary Taylor, æt. 12, entered the women's medical ward June 12th, 1838. Was in the surgical ward a year since with inflammation of the conjunctiva. Had effusion into the cellular tissue in April, 1838, but when it commenced is not known. For several months has had a swollen face and discharge from one of the ears. Says she has not had scarlet fever. Present state, June 13th. Very light complexion; emaciated; prefers lying on the right side; face cedematous; left side more swollen than the right; lips thick and tumid, chapped; eyes partially closed by the oedema; chronic inflammation of the conjunctiva; cicatrix, and ulcer on the cornea of the right eye; left ear discharges a reddish, sanious matter; no œdema of upper extremities; abdomen distended, but gaseous on percussion; effusion inconsiderable; lower extremities much infiltrated and pit on pressure. Heart. Action regular; sounds clear; impulse moderate; no dyspnea; no pain in the abdonien except in the right and left lumbar regions; firm pressure there produces deep-seated pain; pressure posteriorly in the region of kidney painful also; not elsewhere. Slept well; appetite good; no urinary excretion for eighteen hours; no evacuation from the bowels; no sweating; skin cool, dry; pulse 90, feeble and small; urine not tested. Prescription. Good diet and the following mixture:-Baccar. juniperi 3 ss.; potassæ bitart. 31; Infunde in aquæ Oi.; sumat f. 3 iv. ter die. June 13th, P. M. Nitric acid added to the urine gives a copious albuminous deposit. June 17th. Skin of face of a bluish white colour; œdema of face and limbs slightly diminished; effusion of the abdomen as before. Seems more lively than at entrance; strength increased; feels better; sleeps well; no appetite; great thirst; tongue glossy, and of a pale red; left ear continues to discharge copiously a sanious matter; complains but little of pain in the ear; sweating at times; skin now dry and cool; six to eight evacuations in the twenty-four hours, no blood in them; urine, about a pint in the same time-coagulates by the addition of nitric acid and the application of heat; no pain in the abdomen, except in the region of the kidneys; pulse 100, small. Takes her medicine reluctantly. Prescription. Continuetur infusum baccarum juniperi et bitrartratis potassæ. R. Pul. digitalis; scillæ aa. gr. ss.; fiat pilula ter die sumenda. June 19th. Feels better, sleeps all night and during the greater part of the day; appetite bad; thirst continues; skin dry; temperature about natural; no sweating; tongue pale red, shining; oedema of face as yesterday; discharge from the ear continues-also from behind the ear, where the bone is carious; effusion in the abdomen rather less; ædema of legs much less; two to five evacuations in the twenty-four hours; urinary secretion diminished, still albuminous-specific gravity 1004.7, that is, less than natural; soreness in the region of kidney on pressure; no sweating; tongue pale red, shining. Prescription.-Continuetur pilulæ et infusum baccarum juniperi. Omittatur potassæ bitartras. June 22d. In the night of the 20th was delirious.. Last night, slept badly, restless; bowels discharge freely; the evacuations very fetid and dark coloured. The ear discharges a more fetid matter, some of which runs from the mouth. pro renatâ. Prescription.-Omittantur pilulæ et infusum. Capiat misturam cretæ 21st. Is now delirious; desires to get up; urine increased in quantity; strength very much diminished; speaks very slowly; oedema of face and legs the same; dozing constantly; rolling of the eyes; pupils a little dilated, and contract slowly on the application of light; abdomen very tender on pressure; effusion in the abdomen not diminished; percussion of the abdomen gaseous; extremities cold; cold sweats on the face, extremities, and neck; pulse scarcely perceptible, cannot be counted at the wrist; heart 92 pulsations; respiration 15, costal. Prescription.-Ammonia carb. gr. iii.; spt. æth. sulph. comp. m. xv.; emulsion. comm. 3 iss., fiat haustus omni horâ sumendus. Sinapism and bottles of hot water to extremities. June 22d, P. M. Bowels constantly open; the discharges of a gangrenous odour. Died at 8 o'clock, P. M., of June 22d. Brain of good consistence and colour, no marks of inflammation. The temporal bone carious; internal structure of ear destroyed; an extensive cancrum aris, which has destroyed a part of the superior maxillary bone, and communicates with the antrum highmorianum. Necroscopy, fourteen hours after death. Exterior.-Emaciated; infiltration of the lower extremities. Abdomen. About a pint of serum was found in the cavity of the peritonæum, of a light colour; coagulates by heat. Mesenteric ganglions nearly all tuberculated; three or four of them, of the size of a pullet's egg: when cut into, of a straw colour, and present the appearance of old cheese; nearly all enlarged. Kidneys-larger than usual; external membrane not adherent; right kidney presenting a mottled appearance, the lower third of a very light colour; when cut into, the cortical, substance is slightly granulated in the part corresponding with the light colour externally; tissue firm; left kidney also of a pale colour in spots, and the internal corresponding portion granulated. Small Intestine.-Near the ileo-colic valve a few scattered tubercles. In the lower third, at intervals of two or threei nches, extensive ulcerations from one half to three quarters of an inch broad, and entirely encircling the intestines; presenting a bluish appearance, corrugated, with elevated edges. Some of them correspond to the enlarged ganglion, in the mesentery. In ascending the canal, the ulcerations become fewer and smaller; mucous membrane pale; attenuated glands of Peyer developed, but healthy. Large Intestine.-Liver and spleen normal; several living ascarides lumbricoides in the intestines. Thorax.-Two or three ounces of serum in each pleura; no adhesions of the pleura; no tubercles in the lungs. Bronchial glands extensively tuberculated. A. M. VEDDER. 2.-Case of Vicarious Menstruation. Reported by EDWIN A. ANDERSON, M. D., of Wilmington, N. C., one of the Senior Resident Physicians. H. S., born in Philadelphia, age twenty-two years. An inmate of the asylum for the last four years on account of periodical attacks of insanity, connected with vicarious menstruation. From the age of puberty until that of eighteen, the catamenia were regular; mind clear, with no disposition to insanity. About this period she was attacked with transient and irregular paroxysms of insanity, lasting from a quarter of an hour to an hour, attended with sometimes partial, at other times complete, suppression of the catamenia. The mode and time of these attacks could not be certainly known, either by patient or attendants; generally, however, slight irritability of temper, with a disposition to flushing of the head, face, and neck, with more or less cephalalgia, could be remarked by an attentive observer. She would be walking about, apparently in good health, conversing cheerfully; when, suddenly falling, she would strike her head against any thing in the way, often severely injuring herself; and, when conveyed to her apartment, would remain entirely insensible to all surrounding objects. The head, face, and neck now became congested of a bright scarlet hue, with coldness of the extremities, and low muttering delirium. This state continued for about ten minutes, when ejection of dark, grumous blood, sometimes to the amount of four ounces, supervened. This was known to proceed from the stomach by the complete absence of the pulmonic physical signs during its ejection-respiration being entirely natural, at times only slightly hurried-and by its dark colour; blood from the lungs being usually of a much brighter hue, approaching to the colour of scarlet, and frothy. After this the symptoms become entirely relieved; warmth returns to the extremities; the congested head, face, and neck resume their natural hue; and, in from three quarters of an hour to an hour the patient recovers, much exhausted, with a disposition to sleep. Next day she remains entirely unconscious of all that occurred, either during the attack or some hours previous to it; the faculty of memory being for the time suspended. Complete retention of urine precedes and attends most of these attacks, the bladder being greatly distended; with severe pain in the hypogastric region on pressure. Catheterism relieves the pain in the hypogastrium, but has no effect upon the paroxysm: the instrument has often been introduced without her being sensible of it at the time or subsequently. Such was her extreme modesty that some time elapsed before it was discovered that she was suffering under prolapsus uteri to the extent of about an inch and a half. A flat circular glass pessary was then introduced, with relief of most of her distressing symptoms, menstruation becoming regular, and the vicarious menstruation from the stomach ceasing as long as the instrument retained its place and supported the uterus. It was soon, however, dislodged, when the vicarious menstruation, retention of urine, with periodical attacks of insanity, recurred. For more than three weeks a flat circular silver pessary was retained, with entire comfort and ease, and with regular menstruation. It would appear, therefore, that the vicarious menstruation in this case is owing mostly, if not entirely, to the prolapsus uteri; for when the prolapsus is removed, regular menstruation ensues, and if the prolapsus recurs, vicarious menstruation follows, with its attendant distressing symp toms. E. A. ANDERSON. ART. III.-TWO CASES OF BRONCHIAL POLYPUS. 1 And Lecturer on Midwifery at the Westminster Hospital School of Medicine. The term "bronchial polypus" has been quite arbitrarily applied to certain albuminous concretions formed in the air-tubes. As it has, however, been adopted by the few English writers who have described this not very common form of bronchial disease, I retain it; that the cases I am about to relate may not be distinguished merely by a new name from others on record, to which, in every respect they are exactly similar. It may be proper to state, that various designations have been given to this form of disease, by different foreign writers; as angina polyposa, catarrhe suffoquant, asthma rarum, croup chronique des bronches, &c. &c. CASE I.-Mr. B., t. 21, when about four years of age, had been attacked with severe inflammation of the lungs, from which he completely recovered, after an illness of several weeks. No other trace of this, attack remained than a very slight and occasional cough, which did not even excite the attention of very anxious parents. He grew up stout and strong; he was active like other healthy boys, and indulged in the ordinary and violent sports of youth, without shortness of breath or any inconvenience. He continued in good health until the age of seventeen, when his cough became somewhat more troublesome, but not sufficiently so as to prevent him from pursuing an active occupation. He now, also, occasionally expectorated a small quantity of white curdy matter. No increase of these symptoms occurred for a year, when he was quite suddenly attacked with great difficulty of breathing and violent fits of coughing; and for several successive mornings he expectorated a large quantity of substance looking "like a fibrous root with many branches," as his friends, not inappropriately, described these moulds of the bronchial tubes. One of these moulds is on the table, marked 121. He had now some pain in the left side, and could not sleep comfortably when he lay on it. He had no febrile symptoms. In the course of a few days he completely recovered, and he remained perfectly well for two years, having neither cough, dyspnoea, nor expectoration. At the end of this time he was again attacked with slight cough and difficulty of breathing, and, in the course of three or four days, he expectorated many of these "bronchial polypi." As in the former instance, there was no obvious cause for the attack. He had not been exposed to cold, nor had he undergone any unusual exertion. Some of these "polypi" were slightly tinged with blood, in consequence, no doubt, of their firm adhesion to the bronchial membrane. The dyspnoea that accompanied their expectoration was very severe, and one concretion was coughed up with so much difficulty as to threaten suffocation. His breathing had now a whistling sound, and the left side of the chest felt very dull on percussion. For several days his countenance resembled that of a patient labouring under asthma. All these symptoms very quickly ceased, and he has remained perfectly well for more than two years. CASE II-A delicate-looking boy, æt. 17, had always been subject to catarrhal affections, from slight exposure to changes of weather; but he did not present any symptoms of serious pulmonary disease, nor were the catarrhal attacks ever severe enough to confine him to the house. He was rarely free from a slight cough, but it had not been accompanied by any expectoration. Without any assignable cause, his cough rather suddenly increased, and he began to spit up a quantity of white stringy substance. His breathing now became difficult from slight exertion, and a constant mucous rattling was heard when he breathed. On the left side, just above the clavicle, the chest sounded very dull on I London Medical Gazette, March 19, 1838, p. 330. |