Embolism, following Syncope from Post-partum
Hemorrhage.

DR J. S. FLETCHER read before the Manchester Medical Society the follow ing case, which is interesting in several points of view, and is remarkable in consequence of its favorable termination.

"Mrs. R., aged 36, had previously borne two children. She had phthisis sixteen years ago, from which she recovered, but has been delicate. Her brother died of phthisis, and her father of diabetes. She was confined February 12th, with a girl. The delivery was very rapid, and was shortly followed by profuse hemorrhage, which produced slight fainting, lasting for some time. Her recovery was rapid. She was allowed to sit up on Feb. 25th.

"On March 1st, she rose at 10 A. M. She ate rather a smaller dinner than usual; but, in other respects, nothing unusual was noticed. At 2 P M., she was sitting up. The nurse had just taken the baby from her, and turned away; on looking round the moment after, she saw Mrs. R, with her lower jaw dropped, pale, and making signs with her hands. The nurse gave her a tablespoonful of raw brandy, and then got her upon the sofa. Mrs. R. was just able to name her next neighbor, and made signs to send for her. After this she could make no articulate sound.

“When seen half an hour after the seizure, she was lying upon the sofa, pale and much agitated; her head was hot; her hands wet with perspiration; the pulse in right wrist (the only one then examined) 104, full, and jerking. She moved both hands, to express, as it seemed, something wrong about them. The face was somewhat drawn to the left side; and the tongue,when. protruded, was pushed to the right side. All power of articulation was completely gone. Mustard was applied to the back of the neck, to the stomach, and to the calves of the legs. Two grains of calomel were given, and ammoniated tincture of valerian was ordered. In about an hour from the time of the attack, she seemed to recover partially, and again spoke easily and plainly; but in another half hour she again became speechless, though conscious, and able to answer by signs.

"At 5.30, Dr. Fletcher saw her, and found that, though the pulse was easily felt in the right wrist, yet it was scarcely perceptible in the left; it was equally feeble in the brachial artery, but was easily found in the axillary, subclavian, and carotid. She could move both hands, but was unable to grasp with the right. The pulse had now become very rapid and weak. Brandy and sal volatile, and then brandy and ammoniated tincture of valerian, were given every twenty minutes; and afterwards five grains of sesquicarbonate of ammonia and half a grain of ammonio-tartrate of iron, in camphor julep, were given alternately with brandy and beef-tea every hour through the night. Blisters were applied behind the ears. Under this treatment the pulse gradually improved slightly in strength, and was rather more easily felt in the left wrist; but it was still excessively feeble and small.

"2d. 8 A. M. She had dozed a little in the night. Her head was cool; the body was bathed in perspiration. The blisters had risen. The bowels were not open; the abdomen was distended with flatus. She had passed urine voluntarily every half hour. The pulse was 96, stronger in both wrists, but still scarcely perceptible in the left. There was ra her more strength in the right hand, but she was still unable to hold a pencil. An enema of turpentine and soap brought away a copious evacuation and much flatus. During the day, she gradually recovered power in the right side. The tongue, when

D

protruded, was less completely pushed to the right side. The pulse also was diminished in frequency, but retained its force; and in the right wrist it had slightly increased in volume. The urine was pale, of specific gravity 1007, not albuminous.

"3d There was great improvement in her appearance. The skin was cool, not perspiring; pulse quieter in right wrist, stronger in left. She could hold a pencil in the right hand, and wrote several words on a slate withou much difficulty.

"5th. She articulated several words for the first time, as 'baby, papa, beef-tea, good night.' She wrote that she felt more natural alotgether, but complained of pain in the left shoulder, and of tingling in the left arm and leg. The bowels were regular; the pulse better.

"6th. She seemed more nervous; had presentiments of impending evil. The pulse was softer and weaker. She wrote that the sense of smell, which hrad been impaired was now all right again.

"From this time, her progress was steady, but slow. Her speech was not perfect even so late as the end of May; but her strength had so far returned that she was then able to go away from home.

"The treatment by sesquiicabonate of ammonia and smail doses of iron was continued throughout, with increase of dose, and the addition of a quantity of the tincture of nux vomica."

The carbonate of ammonia was given in accordance with Dr. Richardson's theory as to its action in maintaining the fluidity of the blood.

Dr. F.'s theory as to the pathology of this case, is: "that at the time of the hemorrhage after labor, a small clot was formed, which,' during the time of feeble circulation, probably contracted some adhesion to the walls of one of the heart's cavities-most probably the left ventricle-and when the circulation became more energetic, this was detached and moving along the aorta was arrested at the left carotid and the left subclavian arteries, into each of which it entered, fitting on the small portion of the aartic wall between them in the form of a saddle; from which spot a portion was probably detached to be carried into one of the cerebral arteries at the time that she for the second time became speechless and partly hemiplegic, and the second time became the lower end of the brachial when it stopped the pulse.

"It will have been remarked that in the account given of the symptoms, the left side was the one in which the circulation was interrupted, whilst the right side was the one partially paralyzed—this agreeing with the general Fule as to cerebral paralysis.

"Another remarkable feature in the case was, that as the pulse improved in the left wrist, the use of the right arm also returned; and these two symptoms seemed to move on together-to me very clearly telling of the same process of removal or absorption of the several clots. This is remarkably seen in the account of March 3d: Pulse quieter in right wrist; stronger in left; can hold a pencil in right hand.'

"On the 5th, she could write words; and on the 6th, smell returned. It was a remarkable feature in the case that, although perfectly conscious, she could not for more than a week recollect the words she desired to write on her slate, and would very often use wrong words; indeed it was some weeks before she could always recollect the words she desired to use.

"This lady had been for years subject to rheumatic pains; but she had never had any severe rheumatic attacks; and, although I am quite aware that rheumatism has been found to be often associated with cases of embol ism, I cannot suppose that this had any relation to this case-as I think it will be found that it is only in those cases of rheumatism giving rise to heartdisease that any connection can be traced between the two conditions.

"Certain conditions of the blood woold undoubtedly give a disposition to he formation of clots, by deposit from the blood itself; and the condition of rheumatism, I apprehend, may be one of these.

"In considering the question, as to whether or not an embolism can be formed in the blood by simple coagulation of a portion of its fibrin without the existence of any organic change in any part of the heart or blood-vessels --as I believe to have been the case here--we must remember that coagulation of blood takes place much more readily with a slow and feeble circulation, and that after great loss of blood there is generally a relative excess of fibrin and a much quicker coagulation of the blood (Day), whether this loss occurs by blood-letting or by hemorrhage.

"Pregnancy, too, has its own particular condition of blood, viz.: a low specific gravity, from an excess of water, fewer red corpuscles, and relative excess of fibrin; all circumstances favoring the occurrence of embolism. Her anæmic habit is not an unimportant point in this case, and would aid in the development of an embolon.

"The co-existence of all these favoring circumstances lends additional probability to my opinion, that the case I have narrated was one of the formation of an embolon by simple coagulation; and I think I was warranted in saying that such a pathological condition does occasionally occur. The prognosis in all such cases of embolism would be more favorable than in those arising from organic disease, from the fact of the clot being less firm than detached masses of old-standing effusions are; and referring to Dr. Richardson's experiments on the coagulation of the blood, we find that he could redissolve the clot of coagulated blood in serum alkalinified with ammonia. This I believe was done in the living subject in Mrs. R.'s case by the administration of ammonia; and I am disposed to give a share of the credit due for the result of this case to Dr. Richardson, for the important additions he has made to our knowledge of the physiology of the blood, although I am quite aware that his conclusions as to the cause of the coagulation have been very ably contested.

"The result of this case has been most satisfactory; for the long continued difficulty of articulation led to some little fear that a permanent difficulty of articulation might be the result, as it is said to be in all cases of recovery from embolism of the cerebral arteries."-British Med. Jour., April 30, '64.

NEEDLES IN THE BODY.-To the many very curious cases of this kind recorded, Dr. F. D. Lente, of Cold Spring, adds (Amer. Med. Times, Dec. 26th, 1863) the following: He states that he was called to a girl, about seven years of age, who had told her mother five months previously that she had swallowed a pin. As no unpleasant symptoms superve .ed, the occurrence was soon forgotten, until a few days before Dr. Lente was called in, when she complained that on stooping down something pricked her in the belly; and upon feeling with her fingers she discovered what she supposed to be the forgotten pin; upon examining the spot, which was a few inches below the umbilicus, after some manipulation I managed to get the two ends of the substance between two fingers, and, on pressing one end outwards forcibly, the point of what proved to be a needle an inch and a half in length projected through the skin, and was drawn out by a pair of forceps. It was blackened and very brittle. No unpleasant consequences have resulted. Dr. Lente also states that he knew an old gentleman, who was engaged in a large mercantile business, who suffered for twenty or thirty years with "neuralgic pains." so they were calied, in different parts of the body, for which but little relief was obtained, and from which his constitution suffered very much. One day, while writing in a private room of his establishment, and rubbing his knee, which was, at the time, the seat of one of his neuralgic attacks, suddenly, to his great surprise, the point of a needle popped out of the skin. Before endeavoring to pull it out, he called in some of his clerks to witness the phenomena. He never afterwards suffered from any of his former attacks,

EDITOR'S TABLE.

Toland's Medical College.

BEFORE this number of the JOURNAL reaches our readers they will have received a lithographic view of an edifice which is being erected by Dr. Toland, and which, as soon as completed, he intends donating to the City of San Francisco, and the profession of medicine, for perpetual use in Medical Education.

When the value of the property, the adaptation and beauty of the structure are considered, no ingenuous man, in or out of the profession, will withhold an acknowledgment that the act is almost unparalleled in real generosity and professional zeal.

In the circlings of selfish interests and personal gains, there is little encouragement generally given to schemes which are not more or less immediate in the fruits of investment. It is hard for any man to break away from those trammeling maxims of parsimony which are perpetually urging the acimulation of wealth, which allow no passing deeds of experimental generosity or indulgence in the surprises of benevolence, and which at the very end of exertion, seldom permit more than a half-delirious distribution of life's carefully-gatbered productions.

The story of one man is the report of most men. If there be exceptions to the common rule, the explanation will always be found in the operation of some powerful motive, too strong for the antagonism of universal precept and selfish instinct.

That is, at any rate, the explanation of this munificent act of Dr. Toland. Throughout his entire professional life, he has steadily cherished the determination to accumulate money enough to enable him to build and establish a school of medicine which should be of perpetual benefit to his profession. It is the thought with which he came to California, and the stimulus that has inspired him to an industry and toil seldom manifested in the fields of exertion. Fortunately for the profession, fortunately for the cause of medical education upon the Pacific Coast, and fortunately for San Francisco, he has succeeded in the realization of a noble and glorious project.

The building is nearly completed, a Board of Trustees selected, a Faculty of Medical Teachers organized, and a regular Course of Medical Instructions advertised for the coming winter.

We have said that it was fortunate for San Francisco that the Doctor had succeeded in attaining this object. When we consider how intimately and seriously the interests of society are blended with the cause of Medical Education, and when we consider the influence of any school of science in attracting patronage, and in consolidating and extending the fame and distinction of any Metropolitan City, we would scarcely doubt the benefit which

the City of San Francisco would derive from the organization and maintenance of a good medical school.

In this respect San Francisco occupies a position in which she can make tributary to medical education a line of coast population of ten thousand miles, aside from the islands of the Pacific, and that vast mass of human beings, the Mongolians, who have shown such an intense and cordial appreciation of an American physician at Pekin.

And while her commerce is continually increasing its area of intercourse with other people, while her connections of trade are blending her more intimately with foreign population, and thereby intensifying the moral influence which her position confers, she must see and feel the necessity of evoking and maintaining every source of accommodation, attraction and fame which are the common essentials of a centralizing power.

Among these necessities, none present a more captivating influence than the practically useful sciences, of which, the Science of Medicine is pre-eminently important, and in no place in the world at the present time is the establishment of a good Medical School more urgently demanded than in San Francisco; not alone demanded by the rapidly extending commerce of California and the prominence already given to her upon the Pacific Coast, but necessary in the proper qualifications of medical men who are to assume the responsibilities of medical practice in our Pacific States.

Any man who watches the modifications which are common to diseases in this country, will not deny the utility of a medical school, if for no other purpose than that of accumulating and diffusing information in respect to these morbid changes and their treatment.

A good school of medicine in this city would be of great present benefit and of incalculable advantage to the future necessities of the coast. And San Francisco has but little to do to develop and maintain such a school.

One of her citizens has done nearly all that is needed. A little encouragement upon the part of her citizens and the authorities, are all that is asked or expected. There is no climate in the world so admirably adapted, and no city in the world where there are greater facilities for medical schools. In every city of the United States where there is a Medical College, the people and the authorities are forward to place at the disposal of such institutions such hospitals and dispensaries as can be of service in the clinical instruction of students.

In New York, Philadelphia, Boston and Baltimore, the charity hospitals are not only put under the professional control of Medical Faculties, but the authorities emulate in seeing how far they can make these institutions the judicious and beneficent means of making men competent for the practice of medicine. The Faculty of this contemplated School have tendered gratu¡tous services in the City and County Hospital of San Francisco, for those privileges of clinical teaching which are enjoyed in every Eastern school. Will the authorities grant this small favor—and will the people encourage an effort to thoroughly supply the Pacific Coast with the facilities of medical education?