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the umbilical region returned; the abdomen became swollen, and very tender; the pulse accelerated and weakened; the breathing painful; general anxiety. In this state we found her on visiting her about eight o'clock. Fourteen ounces more blood were ordered to be taken away, a continuance of the use of the lotion to the abdomen, and the following draught every four hours.
B Tinct. digitalis mx.
Syrupi 3j. M. ut ft. haustus.
Mucilag. acacia q. s. ut ft. pil. xij.
Sumatur ij. cum
In the evening, about eleven o'clock, I saw her again. She had not been at all relieved; the blood was rather buffed; pulse much as before. As the Doctor had expressed a wish that, in the event of relief not being obtained, a repetition of the bleeding should be had recourse to, I, with some difficulty, procured about four ounces more. She, however, continued to get worse, and, about seven the following morning, she expired. Inspection of the body was not permitted.
On the 17th of June 1812, I attended a young lady, about 19 years of age, with her first child. The labour was of about eight hours duration, and perfectly natural. On the second day her bowels were opened, with Infus. senna and Magnes. sulphat.; and nothing unusual occurred till the 20th, being the commencement of the fourth day after her delivery, when she was attacked, about six o'clock in the evening, with pyrexia, severe pains in the hips and back, tenderness and pain in the abdomen. At eight o'clock (my attendance having been required), I found her in the state I have just described, with a pulse beating 120 in a minute, and full; the skin hot and dry; the respiration laboured. Reflecting on the uniform fatality of all the other cases which I had seen, and noticing, in the last case, the inutility of bleeding in the latter stages of the disease, which evidently only tended to hurry on the catastrophe by increasing the sinking, and calling to mind that prominent feature which I had observed in all the examinations I had made post mortem, I mean the amazing accumulation of bile,-and aware, too, that after the fluid was poured out into the abdomen, nothing could possibly avail-I determined on adopting the following plan, I immediately made a large orifice in the arm, and ab
stracted blood till deliquium animi was produced (being desirous that this, if possible, should be the only bleeding), which from the quantity being so suddenly taken, occurred when I had procured about 18 ounces. The symptoms were immediately relieved; and I next turned my attention to a complete evacuation of the alimentary canal. I therefore gave her Hydr. submur. gr. iss. Antim. tartar. gr. 4ta. quaq. hora. Ordered the room to be kept cool, and the patient lightly covered. At half-past ten repeated my visit. The pain in the abdomen was completely relieved; that in the hips and loins continued; some pain in inspiration about the seventh rib; pulse still frequent and full. As the blood was, however, not at all inflamed in its appearance, and the pain and tenderness in the abdomen entirely subdued, I did not judge it advisable to repeat the bleeding, Jest I should reduce my patient too much. I ordered the powders to be continued, together with small doses of magnes. sulph. and ten drops of the tincture of digitalis every four hours. To take light diluent drinks.
21st. Had passed an easy night, and had discharged, by vomiting and by stool, a very great quantity of bilious matter; urine scanty; neither pain nor tenderness in the abdomen upon pressure; pulse still full and quick. Increased the tincture of digitalis to twenty drops every four hours, with a view of lessening the vascular action. After this period she continued to improve daily; had no return of pain. The acceleration of the pulse continued, however, for some days before it subsided, during which she continued the digitalis.
After this, I saw no more of the disease.
The above cases are transcribed from notes taken by me at the time I was attending the several patients. The very excellent and scientific works of Dr Armstrong and Mr Hey were not then published; and I shall feel great pleasure if the contribution of my mite of experience will at all tend to corroborate the propriety of the views they have taken of the disease, and the plan of treatment which they have pointed out for its cure.
Holloway, near London, October 31, 1815.
Three Cases of Inflammation of the Heart, with the Appearances on Dissection. By ANDREW DUNCAN Jun., M. D., Professor of Medical Jurisprudence in the University of Edinburgh.
HE two first of the following cases came under my own observation when I had the temporary charge of the Clinical ward; and it is a very singular coincidence, that they were both admitted on the same day. The last occurred to Dr Spens, to whose friendship and liberality I am indebted for it, Hospital records compensate, by their authenticity, for many imperfections. These cases are therefore printed, without alteration, from the journals kept at the time. For a somewhat similar reason, the remarks I have subjoined are part of those then de livered to my pupils; they were necessarily composed in a very short time, and might have been improved by subsequent reflection and research; but my object is merely to increase our store of facts on an important disease, and to subjoin such observations as arose naturally out of the consideration of those which occurred to myself.
ROBERT BAXTER, æt. 28.—March 11, 1815.—Miner.
Complains of severe headach, and a gnawing pain in the region of the stomach, not increased by pressure, but much aggravated on taking food; with a sense of a ball in the under part of the abdomen, working upwards through the course of the alimentary canal to his throat, when he feels as if immediate suffocation would ensue. This feeling he has experienced almost every night for nearly three months past. Frequently, although not always, at the beginning of each paroxysm, he has a very copious flow of urine, approaching nearly to the colour of table-beer. During the fit his belly swells, and it is always relieved by a great discharge of flatus by the mouth. He is not sensible of foaming at the mouth during the paroxysm; nor, if standing, is he thrown to the ground, but becomes so giddy as not to be able to stand without assistance. He also complains of great debility, want of appetite, interrupted sleep, and a disagreeable taste in his mouth on awakening in the morning. Has a delicate look; pulse 104, of moderate strength; H. natural; tongue covered with a brownish crust, with a clean edge; some thirst; belly costive, in which state he always feels
worst; urine varies; when his complaints are severe, it is increased in quantity, and of a higher colour.
Began to complain about three months ago. Was first seized with the pain and sense of tightness in the region of the sto mach. Can remember no cause for his complaints, except being exposed to cold and hard work. Nothing happened at that time particularly to affect his mind. Says he has used stomachic bitters and bark, without alleviation of complaints. Was formerly troubled with symptoms nearly similar to the above, but never to such a height. Was able always to follow his occupation, and enjoy a good appetite.
12th. Is in the same state as when admitted, but has had no stool for two days. Pulse 105.
Capt. infus. cas. sen. 3ij. om. bihor. donec superv. cath.
13th. The senna operated well, and he felt himself better until about two hours ago; since which time he has been affected with pain in the stomach. Pulse 100.
Int. infus. sennæ.
B. Pulv. cort. Cinchon. flav.
Pulv. rad. Valer. syl. a 3ss. M.
14th.-Complains of general pain in his shoulders and back, and more particularly of griping pain in his bowels. Has also considerable vertigo when he walks, and some little appearance of globus, though not decided; no appetite; no thirst; belly natural; pulse 100, very small; tongue almost clean.
15th.-Passed a better night, but complains of rheumatic pain in the shoulder and down the left side, and also of considerable heartburn, during the paroxysm of which, he expectorated a little blood. Belly loose; urine natural; pulse 104.
Cont. Pulv. valer. et cinchon.
Capt. Carbon. magnes. i. pro re nata.
16th. Slept ill last night from griping pains, which still continue: Has also rheumatism of the back of his neck. Heartburn relieved, and has no globus. Pulse 104; no appetite; some thirst.
Capt. statim haust. anod. cum tinct, opii gtt. xxv.
17th. Still complains of rheumatic pains and of uneasiness after food, but he eats more than the house allowance. Belly natural; pulse 105, small; slept well from the draught.
18th.- Complains of lightness of head, and also of pain in his back; belly and urinę natural; tongue not clean; pulse 104.
Illin. dorsum ung, terebinth.
19th. Still has many complaints of headach, general weakness and pains; slept tolerably; griping pains rather diminished. Complains of pain, even on slight pressure, a little below the scrobiculus cordis, and to the left side. Pulse 108.
Illin. pars affect. tinct. sap. et opii.
20th.-Complains still of giddiness and oppression at his stomach after taking victuals; slept well; pain in the shoulder rather better; pulse 10+.
Capt. infus. anthem. alkal. ij. om. trihor.
21st-Complains of pains in his bowels, increased on pressure; of weakness and giddiness; pulse 104.
22d-Still complains of rheumatic pain in his shoulder; also of pain in the bowels, increased on pressure; pulse 104. Cont. med.
Injic. enema fetid.
23. Complains much of pains in his belly, especially since breakfast; also of giddiness, and great weakness; slept well; says he perspires much; has acidity at his stomach; the pulsation of his heart is distinctly felt, even when lying towards the right side; and he has repeatedly fallen from his chair when sitting by the fire. Pulse 107.
B. Gum res. assafoetid. 3j. Solve in decoct. malv. comp.3x.
B. Carbon. mag.
Pulv. rad. valer. sylvest. a 3ss.
Let him have it ij. of beef tea daily.
24th. The injections came away immediately, and unmixed; he thinks that the pain in his bowels has been worse since; complains still of the soreness of his stomach; is very languid. Pulse 110.
B Infus. gentian, comp.
Vin. domest. a à 3vj. M. Capt. cyath. ter indies. 25th.-Is extremely languid and weak, both in body and mind; bowels very loose; pulse 105, weak; H. natural.
Cont. vin. amarum.
Pulv. cort. cinchon. ass.