« AnteriorContinua »
lotions, fomentation, and cataplasms, all failed in abating this misery; in fact, the mildest application was not endurable; the hip-bath continued to soothe, but the exertion necessary to its use could seldom be borne. Musk, camphor, opium, and æther, occasionally afforded a little mitigation of the spasms, the latter most. Two new small hæmorrhoidal tumours suddenly appeared, which became so exquisitely tender as to make even the approach of the bed-linen a source of fearful apprehension ; leeching eased them for an hour, but no longer. I removed them, but the spasms continued as obstinate as before, originating at the anus. Still its sphincter manifested no tumefaction or inflammation. The stools, now always copious, dark-brown, fetid, and containing black granules like gunpowder, occasionally intermixed with dark green scybala. The infusion of cusparia, with columbo and opium, appeared serviceable ; the pulse was very feeble and intermitting; thirst intense; occasional delirium ; tongue brown; skin hot and dry, unless when the whole body was shaken by the spasms; then a cold clarominess supervened; there was rarely any blood voided; never any membranous or creamy mucus. 1814, January 8th.-Spasms continue dreadful; particularly severe on the approach of sleep, when the shock is tremendous; exhaustion and opium combine to induce a shortlived torpor, which sometimes takes place, while her limbs are firmly held by attendants. The left parotid swelled suddenly, and became extremely tender. The appetite for some time has been nearly gone; emaciation is rapid; all the former old pains are as it were absorbed in that of the lower part of the rectum, which sometimes darts towards the pubes. There are now pus. like evacuations, with points of bright-red blood coming off once in two or three hours; feces once only in two or three days, of the usual calibre, dark colour, and highly fetid. January 14th.Spasms considerably abated, but not gone off; pain intolerable, with a pushing fulness at the posterior part of the anus. This protrusion consisted of two lips, with a middle fissure. With the greatest caution and extrenie slowness, I passed a probe through this aperture. The instrument discovered a cavernous hollow, admitting three parts of its length before it met with resistance; and when it did, its point gave her no pain. It took the direction of the tumour in the bowel. Pus-like stuff, mingled with clots of bright blood and feces, descended through this aperture. The anus began to lose its retentive powers, bui not pain. Unintermitting lever, and the thirst extreme. Extr. ot hyoscyamus, combined with opium, gave more relief than any dose of the latter alone. The issues, which had been long closed, now reopened their surfaces, secreting a thick acrid sordes. The anus
being at this juncture free from tumours, admitted the smallest sized pipe covered with suet, through which was slowly injected Gelat. amyl. Ziv. Pulv. cinchon. zi. P.gum. opii gr. vi. This com- , pound afforded some ease, but the abrupt appearance of a large hæmorrhoid soon banished its use. At this period, Dr Thackeray saw this lady, and thought the copaiba had better be tried again, with hyoscyamus. It was, -- but the stomach rejecting it occasionally, and it appearing to increase the number of stools, it was laid aside, although this was not the fact; a miserable one had taken place,-she had wholly lost the power of retention, so that, when lifted into an upright posture, the contents of the pelvis ran off involuntarily, so far as related to mucus, blood, and feces ; she then rendered the urine as in health. The large hæmorrhoid shot out a fungous point, which would not admit the touch of a feather. The pain in the anus is still intense ; the scalding sensation continues; the spasms are nearly gone off.
January 31st.–Facies Hippocratica. In the evening I was desired to look at an evacuation which had rushed off suddenly. It was about a pint of dark clotted blood, with a few ounces of bright-red; fainting followed this loss; the pulse was imperceptible at the wrist. February 6th..A second hemorrhagic flow was announced by a few bloody spots, resembling what is ejected after the extraction of a tooth, floating on a dark granulated and highly fetid stool. In a few hours it took place as before, followed by syncope and delirium. Some of the clots were of an oval shape, and firm fibrous texture; small ones were seen entangled in the breach between the anus and the coccyx. A sudden tumefaction, with inflammation, and great tenderness of the left labium, was discovered; spasms entirely removed. February 8th. -The tumefied labium burst, discharged pus, blood, and feces; delirium wholly abated. February 10th. --Some frothy spots of bright blood appeared on the fecal matters caught on the cloths placed under her. I mentioned my fears to her mother, that a farther hemorrhage was threatened. At four o'clock next morn ing this event took place, the blood pouring in great quantity from the anus and vagina. On my arrival, I found her very cold, and speechless. Warm flannels and æther revived her a little. Speech returned, and she still complained of pain at the anus and pubes. The catastrophe approached ;- no pulsation could be perceived even in the neck ; dyspnea, with pain in the breast, supervened ; the sense of load in the thorax she observed increased; the extremities were quite cold to the touch. Still her senses remained, which enabled her to take a most affectionate leave of her friends. At eleven o'clock she sunk gently into the arms of death, without a groan or a struggle.
Dissection Saturday, February 12th. - examined the body in the presence of Dr Thackeray and Mr Bronfield, surgeon of this city. The abdomen was tensely swollen, all other parts of the body greatly emaciated. There was a copious flow of feces and dark, coloured fetid blood from the anus and vagina, which now ap. peared to form a common cavity, no perinæum being percepti, ble. On dividing the abdominal integuments, the quantity of intensely yellow fat which presented, was considerably greater than could have been expected ; but the muscles were as pale as thopgh they had been washed; the omentum was large, fat, and adherent to several of the intestines, dipping very low down into the pelvis, among the convolutions of the bowels, even under the cæcum. The liver was large, extending fully across the stomach, to the left side, so that but a very small portion of the latter viscus was in situ ; the gall-bladder small in proportion to the liver, and containing not more than a tea-spooniul of pale bile ; the ducts perfect ; the whole liver sound, but pale ; the sto. mach firm, empty, and very white ; the pancreas and spleen as they are usually found in healthy subjects, except the latter ber ing smaller than ordinary; the whole intestines distended with flatus and feces, and of a very pale hue; the cæcum occupied all the upper part of the pelvis. On tracing the duodenum je: junum and ileum down from the stomach, they were found but little altered froin their usual state, excepting having a very pale appearance, and their valvula conniventes obliterated, or very small throughout. At the inferior portion of the ileum scybalous feces were found, and no regular valvę; and just where the cæcum commences, a slight inflammatory blush was perceptible. The mucous glands were here large and pappy, the cæcum itself fully distended with hard and soft feces of a light brown colour, highly fetid. Upon elevating this bowel very gently, its contents issued through an aperture the dimensions of a shilling, its edges not ragged ; but the inferior portion of this bowel was so thin and tender, that I was not quite satisfied it had not ruptured in the mere elevation ; but as it had rested on a mass of putrid blood and feces in the pelvis, I am inclined to believe the weight of its contents had burst it. The inner surface of the gut was nearly as smooth as the outer, with here and there a dark bluish coloured spot resembling a shriyelled fold of membrane; no yalvular appearances ; tbe appendix small and empty. The commencement of the colon small, and seemingly incapable of admitting the scybalous feces lodged in the cæcum to pass without some violent effort ; yet it did not feel thickened or strictured. The blood-vessels just here were more full than anywhere else, and this was one of the spots where the subject had complained of severe pain. The intestine was slightly adherent to the right kidney. On approaching the stomach, its capacity was greatly increased, but its parietes so tender, that, upon attempting to raise it with the greatest gentleness, it burst, and emitted a very large quantity of light brown coloured highly fetid soft feces, without scybala. On removing this huge load, the same bluish wrinkled folds appeared as before described in the cæcum. The whole descending colon was adherent to the subjacent parts, down to the sigmoid flexure; the left kidney much smaller than the right, and its ureter not to be traced. The colon everywhere yielded to the finger like a rotten membrane ; its whole external surface studded with little 'masses of white fat resembling spermaceti. There was no appearance of valves or glands to be discerned, but innumerable livid eminences; the calibre of the whole bowel was greatly enlarged. The mesocolon lost all its firmness, and was become very white and thin ; no enlargement of the mesenteric glands was discovered. At the sigmoid flexure of the colon, there was a complete breach, the dimêtisions of a penny-piece, through which blood and feces passed into the pelvis. The parietes of the intestine continued for about two inches, when it formed a ragged termination, so that the commencement of the rectuin was but barely discoverable; from hence to the atigs not ä vestige was left. Upon passing a bougie through the opening behind the anus, another throngh that aperture, and a third into the vagina; they almost imntediately met under the uterus. This organ having a very white appearance, and rather hard feel, lay upon the coccyt, which bone felt a little abraded. The ovaria were of the tisual size, and as wliite as the eye of a boiled fish. The lateral ligament of the left side was destroyed, that on the tight was much thicker and harder than common. The peritoTeum covering the bladder was much thickened, and firmly ad. herent to the viscus, which was small; and at its posterior part found adhering as close to the upper surface of the neck of the uterus as its upper part was to the peritoneum. The blood-vessels everywhere connected with the examination were empty, and any muscular substance divided, pale, and flabby. The boney structure of the pelvis was narrow, although not ill-proportioned, excepting a little projection of the last lumbar vertebrze with the sacrum, forming å spinous edge, might be considered as of this description.
It may be proper to remind the reader, that the colon in every part of its course had been the seat of much suffering for near six years, particularly when stooping or bending the body, or from the agitation of sneezing or coughing, both of which the sufferer greatly dreaded.
Chester, May 1, 1816.
'Observations on the Cure of Cancer of the Womb by Excision.
By F. Bj. OSIANDER, Professor of Midwifery in the University of Göttingen.
can afflict the female sex. More frequent in many places thani is commonly believed, it commits greater devastations in an insidious but malignant manner, and does more harm than many other diseases,- and has seldom yielded to any external or internal remedies hitherto used.
The superintendence for many years of the Royal Clinical Hospital of Göttingen having given Professor Osiander frequent opportunities of examining and treating persons suffering under this disease, he, with the active assistance of the young physicians and surgeons who frequented his clinicum, employed, in many such cases, all the means, external and internal, which were known or imagined, in order to ascertain by what means, or by what mode of treatment, a stop could be put to the progress of this terrible disease ; but he learned from experience the melancholy fact, that little else could be done with it than, in a few cases, to retard its progress, and render the sufferings of the patient more supportable; that is to say, the pain, the bleeding, and the bad smell ;-to effect a cure seemed absolutely impossible. Long before he attempted any operation with the view of curing this disease, he conceived it might be possible to cure cancer of the womb by excision, in the way that has been long known
This paper was communicated by John Thomson, M. D. Professor of Military Surgery in the University of Edinburgh, at the request of the author. It was published in the Göttingische gelehrte Anzeigen so long ago as the 13th August 1808 ; but, when the subject is important, and the information new, the date of a communication is of no consequence, except as a historical fact. Editor.