hæmorrhage, as I was told, having begun four hours before. The woman, who had fainted from great loss of blood, was suffering severe pain. Hypodermic injections of morphine seemed to control both pain and hemorrhage. The physician who had first been sent for arrived the next morning and introduced a tampon composed of strips of cloth wet in cold water. That night they allowed the tampon to remain in the vagina, through fear that its removal would cause a return of the hæmorrhage. I was again called at midnight, when the patient was complaining of severe pain and a feeling over the lower portion of the abdomen as if she were "all gone." I was informed that there had been no hæmorrhage. The tampon was removed immediately, and stimulants and nutritious food were administered. The next morning, we visited the patient together and found her dying. The fundus of the uterus had been ruptured from one Fallopian tube to the other. Some months before, this patient, who was nearly fifty years of age and thought she was passing the menopause, visited me, complaining of morning sickness and certain other symtoms, and asked if I thought she was pregnant. told her I thought it was not at all probable that she was pregnant, but that it was likely some uterine irritation was the cause of her symptoms, and I proposed an examination. But she refused, and went to a neighboring physician, who first treated her for symptoms of colic, and, finding that no relief was obtained, proposed an examination, which was then consented to. The physician found a fibroid, projecting from the uterus, pushing the mucous membrane of the canal before it, and during the examination this covering burst, and the tumor fell out upon the floor. At the post-mortem examination, the original attachment of the fibroid was discovered, and in addition there was the rupture of the uterus before mentioned. I I believe that tampons, in such cases, unless used with great caution, are sources of danger. A CASE OF LEAD-POISONING. By R. H. SABIN, M. D., of Albany County. NOVEMBER 1, 1883.-I was called at midnight to see R. R., a young man, aged sixteen years, and learned the following: He had taken his place for a dance at a small social party, was seen to leave and behave strangely, and was caught by a friend who kept him from falling. He was taken into a drug-shop, where a physician saw him and administered fifteen drops of aromatic spirits of ammonia, after which he seemed to partially recover and was carried home in a chair by four or five men, twisting and squirming as if in severe pain. I saw him soon after and found him lying on the floor, with pillows under his head, insensible, but with every indication of severe pain in his bowels. I gave him a hypodermic injection of morphine, gr., and atropia, gr., in the abdomen. In a few moments he was quiet and was put to bed, with warm applications to his feet and legs and cold to his head. I then left him for the night. He remained quiet until toward morning, when he began to be restless. I saw him about 8 A. M., still insensible, pulse 96, temperature 981°, and very restless. The bladder was full, and was emptied with a catheter. I gave nearly a teaspoonful of calomel, which was partly wasted, to be followed by an enema of soap and water. I directed that the head be kept wet with cold water, and gave aconite every hour. 2 P. M.-Bowels not moved; is restless and moans; rolls from one side of the bed to the other; has passed no urine; bladder emptied by the catheter. I gave a tablespoonful of cascara cordial, to be followed with enemata of soap and water. Pulse 90; temperature 98°; still insensible. 7 P. M.-No movement from the bowels or bladder; is restless; moans often; pulse 80; temperature 98°. 8.30 P. M.-I saw him with Dr. Ferguson, of Troy, and Dr. W. B. Sabin, of West Troy. Pulse 65; temperature 98°; insensible; no movements; gave cascara cordial every two hours, and brandy and water; drew his water, and left for the night. The patient died about 7 o'clock next morning, thirty-two hours from the time he was first attacked. He had been at work for some time in a paint-shop, rubbing paint on cars. There was the characteristic blue mark along the edge of the gums, indicating lead-poisoning. On the day that he was attacked, he had been painting a house for his father, and complained of feeling cold while at work. His father said his bowels were usually very constipated. This case was undoubtedly one of lead-poisoning, the symptoms being of an apoplectic character, which sometimes, but very rarely, are observed in this disease. There was probably a rapid effusion on the brain, which produced the insensibility, and which in time began to affect the circulatory centers, as was seen by the rapid fall in the pulse-beats. Just before the patient died, he had two good movements from the bowels. No autopsy was allowed. Two other cases of lead-poisoning occurred among workmen from the same works, both of which recovered. CHRONIC MERCURIAL POISONING. By CHARLES BUCKLEY, M. D., of Monroe County. IN December, 1863, Mrs. K., aged thirty-four years, native of the United States, married, the mother of six children, the youngest being six months old and nursing, presented herself at my of fice for treatment, with the following history: About two months previous to her calling, she was annoyed by a burning, tickling sensation in the mouth and throat, and a disagreeable taste, which was soon accompanied by cough and slight frothy expectoration, pain in the chest-walls, a sense of pressure and want of breath, palpitation of the heart, and pain and burning in the stomach and bowels, increased on taking food. There was constipation alternating with diarrhea, and a craving appetite; but solid food caused such distress that it was seldom taken. The above symptoms were accompanied with violent headache, wakefulness, chills and fever, cramps in the limbs, partial loss of muscular power, dizziness, and tremors, the last named being more particularly marked on articulating. The voice was quavering, the facial muscles involuntarily twitching during conversation. The face was full, pale, and puffy, and the whole body large, which caused the lady considerable anxiety, as she was larger in the abdomen than before the last accouchement. Notwithstanding the small amount of food taken, the bodily weight increased. The tongue was large, flabby, with a yellowish-white coating in the center, gradually fading to the edge which was extremely pale. The pulse was 70, temperature 97°, and the respiration 22 and irregular. On physical examination, moist bronchial râles were heard at the root of the lungs, but no dullness on percus sion was observed. Antacids, nervous sedatives, and tonics were prescribed, a specimen of the urine was requested for examination, and the patient was asked to report in a few days. Having obtained and examined the urine, nothing abnormal being found, an examination of the abdominal and pelvic organs failed to reveal pregnancy, and no disease of the organs could be detected. In the mean time all of the symptoms increased in severity. Perfect rest and a strictly liquid diet were ordered. Bismuth and oxalate of cerium, for the nausea and burning, and tonics were prescribed. A diagnosis of nervous prostration was made, but I was unable to ascertain its cause. The domestic relations were happy, she "having nothing to disturb her." Several office-visits were subsequently made. In the mean time, the patient gradually became worse, and, on January 29, 1884, I was called to see her at the bedside. She was then troubled with constant retching and vomiting, and everything swallowed was immediately rejected. Anti-emetics, ice, champagne, carbonated water, etc., were no sooner swallowed than rejected. Opium or any of its preparations, owing to idiosyncrasy, could not be used. The temperature was 97° and the pulse 100. A cold, profuse perspiration covered the body. The breath was very offensive and could be readily perceived on entering the room. The vomited matter consisted of mucus and bile. There was great prostration of the nervous system and mental faculties, with wakefulness. Short naps only could be taken, accompanied with frightful dreams and a sensation of falling and impending danger. The patient continued in the condition described for about six days, being visited twice daily during this period, when a gradual improvement took place in the stomach and intestinal troubles, with slight abatement of the nervous symptoms. When arising, or raising the head from the bed, objects in the room seemed to move and dance around. The visits were continued until February 9th, the condition gradually improving. Solid food in moderate quantities could be taken without distress, and everything pointed to a speedy restoration to health, when it was no longer considered necessary to visit the house, and she was discharged. |