Gambar halaman
PDF
ePub
[ocr errors][ocr errors]

tention was first called to an examination of the enlarged mamma, and I found all the usual evidences of simple sarcoma present, with nothing of a malignant character. The skin and subjacent tissues

seemed as healthful to the touch, and as free from uneasiness when - handled, as any other mass of flesh about the body. Its size already amounted to great deformity, and was obvious to any passing observer.

I did not hesitate to advise her intelligent owner, that an immediate operation was the only certain cure; and pointed out the danger should amputation be deferred, that might result from pregnancy and accouchement, in the development of some malignant tendency, or at least, subjection to severe suffering.

The force of my suggestions was appreciated ; but fearing the operation, and trusting 10 some happy, fortuitous change, it was neg. lected. She became pregnant, and at the full term of gestation in January last was delivered without any unusual difficulty, and soon felt pain in the enlarged breast for the first time. At the expiration of six weeks, it had grown so rapidly, that while sitting upright the enlarged mamma rested on her lap. It was enormously distended, and of such weight, that however well supported, her chest was strongly inclined forward. I could never detect any circumscribed induration, nor any other evidence of the formation of abscess. She was put upon strict antiphlogistic treatment, medicinal and dietetic. General and local depletives, emollient fomentations and poultices, to relieve turgidity; and the occasional application of the pump and cup to the nipple to encourage a discharge of the milk, should any possibly be secreted.

While these means were being applied, a spontaneous discharge occurred from about an inch above the nipple--in a cortinued stream it incessantly poured out, until one gallon and a half of a milk-like fluid had come away. Immediate and complete relief was expressed, and no appearance of debility, or other adverse symptom, as a consequence of the sudden and almost incredible quantity dislodged, was observed.

From that time, the breast gradually assumed the size it had atlained before her accouchement. Her general health and strength improved daily, and in a short time she was out on the farm at labor, though of an easy kind, and self-imposed. While thus employed, she was exposed to a drenching rain, and in a few days I was summond to visit her again.

I found her now labouring under an acute rheumatism, in its most dangero s and painful form. The pleura was implicated, and a manifest tendency to low typhus rendered her condition very critical.

When we found that she might possibly survive the attack, my altention was again directed to the condition of the diseased breast. Upon examination an ulcer was found, situated near the nipple-the breast again greatly increased in size. The ulcer discharged matter of a thin purulent character, and most noisome odour. Other ulcers were formed, and they soon numbered seven, emitting vast quantities

[merged small][ocr errors]

of insupportable horrid pus-like fluid. By patient perseverance in the use of the chloride of lime, charcoal poultices, and a variety of astringent injections, the discharges assumed a more healthy appear. ance and less offensive odour.

The patient was now a miserable looking object of emaciation; and to every one her death seemed inevitable. It would be needless to dwell upon the treatment here, constitutional and local.

The largest and most pendent ulcer presented a prominence in the cen:re, which I found to be insensible. Upon raising it with the forceps, I was surprised to find that by gentle traction a considerable mass was drawn out without any pain. I applied the scissors and separated that portion. There was not a drop of blood discharged. I then seized the remaining mass with a small tenaculum, and readily drew out in a string-like form, a connected volume of flesh coloured substance, until by the pain produced, I supposed the mass to be too large to pass through the ulcer, and again detached it with the scissors.

I now found a large hollow chasm left under the ulcer, and changed the position of the breast to examine the other ulcerated openings, but as they were situated above, nothing unusual presented at them; but when restored to the same situation again, I found the chasm oc. cupied, and another mass presenting. By pulling gently with the forceps at different points, I succeeded in starting another slough through the ulcer, which passed easily, until one entire mass of large size fell from it without the use of any excising instrument. No blood followed, except what escaped from the edges of the dilated ulcer.

There was now an extensive, unoccupied space, left by the large volume of detached slough; and by the aid of the light admitted through the several ulcerated openings, (I fancied,) was seen the original "bona fide" gland, bounding the upper part of this space.

As nature had performed the amputation so well, thus far, I determined not to interfere, in the already exhausted condition of the patient, by removing the now redundant skin.

Our next care was to ascertain the amount of the self-amputated mass, which was attached to the hook of a pair of "draw-spring steelyards, (the only means of weighing at hand) and weighed one and a half pounds. The small fragmenis, not weighed, Col. M. supposed would amount to at least a half pound more.

We were surprised, at first, that so much bulk and volume should weigh no more; but upon careful examination, I found it composed of a cellular structure, comparable to honey-comb, interspersed with fine particles of a "coffee-ground" colour. The breast was bathed with infusion of red-oak bark, and covered with a large poultice of the same excellent astringent, moistened with solution chloride of lime, and secured by means of bandages, bound on so as to exert due compression on the now flaccid paris. General directions were given for future management, and I did not see the patient from that time, which was 24th of April last, until a few days since, when I visited her, in order to report upon her present condition.

She has been doing the labour of a hand upon the farm, for some two months now. The remains of the mamma are about half the size of the well-formed natural one-the skin is regularly contracted and adherent-the ulcers are all healed soundly, except a very small per. foration, still giving exit to some discharge, of inoffensive appearance. Her general health is perfect in all respects, having recovered her former flesh, activity and cheerfulness of mind.-Southern Med. and Surg. Journal.

Remarks on the use of the terms" Congestion" and " Congestive." By Thomas C. Brown, M. D., of Woodville, Miss.—The term Congestive Feder has become so familiar in the South and West, that the young and inexperienced are led to look for a distinctly marked and peculiar fever, and are sadly perplexed in their investigations. At one time it is described as “algid intermittent fever," at another as “malignant or pernicious remittent fever." They find it supervening on intermittent, remittent and continued fevers-on gastritis and gastro-enteritis-on typhoid pneumonia—on epidemic dysentery; and in fact, as complicated with most of our summer and autumnal diseases, and sometimes with our winter epidemics.

Would it not be well for the medical profession, if our journalists and teachers of medicine, would teach that “there is not, properly, any fever characterized by congestion in contrast with another which is without it;" but that congestion is common to nearly all fevers, whether intermittent, remittent, or continued; and that it is not limited to any one organ: the brain, the spinal column, the lungs, the liver, the spleen, the kidnies and abdominal viscera, may be the seats of congestion, either separately or several of them at the same time; and these as they are separately or severally affected, will cha. racterize the symptoms according to the organ or the several organs which may be involved ?

The term Congestion comes from the Latin congero, to amass, and in a medical sense conveys the idea of turgescence or fulness of blood in a particular part, and implies simple engorgement and over distension of the blood vessels. It seems rather the result of irritation than of inflammatory action, and when it passes into inflammation, it would seem to be more dependent on the general state of the constitution, on the plethoric condition of the blood vessels, with he tendency towards inflammatory excitement, than on the primary irritation which occasioned it. The presence of internal congestions must, of course, be inferred from the symptoms which indicate them, and to connect the symptoms with the structural lesions which they denote, so as to furnish practical guidance in the treatment of them, is the proper object of medical research.

Their treatment must depend in part on the nature of their site, but principally on the cause which occasions them. If congestion result from a plethoric habit, mere local treatment can never give peralanent and effectual relief; on the contrary, if the congestion be owing to irritation only, then general depletion is unnecessary, and would be injurious.

Congestion generally precedes, but may follow inflammation, by the irritation set up in neighbouring organs, or be transmitted to those more distant by nervous influence. Strong innervation, in which the nervous centres are much excited as under various emo. tions, will produce congestion, at one time of the brain, at another of the lungs or liver. Certain nervous affections, as hysteria, will give rise to irregular determination and retardation of blood, producing congestion in some organ, which often entirely disappears after the removal of the nervous disturbance. Congestion dependent on mere nervous disorder, will generally be irregular or periodical in its appearance, but if there be a permanent disorder of function in an organ, the congestion depends upon permanent irritation. In the commencement of fevers the congestion is of an irregular or periodic character, but when occurring in the latter stages of fever, it is usually of a more permanent and dangerous character.

Congestion, coming on in the progress of intermittent and remittent fevers, is of frequent occurrence, and when supervening in the latter stages of these diseases, it generally indicates great danger; but when it ushers in an intermittent fever, and the paroxysm is followed by very feeble reaction, it indicates great danger.

The symptoms of the congestion of a particular organ, or of several organs, combining with the sympathy of a particular fever or disease, upon which it supervenes, must, necessarily, give rise to great diversity of symptoms, and will require a variety of treatment as dictated by the existing circumstances. Hence the confusion which results in an attempt to study the symptoms of congestive fever, as a distinct species of fever. If we are to have a nosology, in which congestion is to be the cognomen of a particular species, we must adopt a division of fever somewhat like the arrangement of Armstrong, and dispense with the distinctions of fever into intermittent, remittent and continued.—New Orleans Med. and Surg. Journ.

Blindness Caused by the Use of Sulph. Quinine. By John McLEAN, M. D., Prof. of Materia Medica in the Rush Medical College. -Quinine when freely administered produces a species of intoxication, tinnitus aurium, a sense of fulness in the head, cephalagia, and other affections; and sometimes, although not so frequently, blindness, more or less lasting.

M. Trousseau, relates the case of a tailor, who, for the relief of a periodical asthma, took 48 grs. of the sulph. quinine, at one dose. In four hours he experienced ringing in the ears, dulness of the senses and vertigo; and in seven hours, he was blind and deaf, his mind wandered and he was unable to walk. These effects, for which no active medicine was administered, gave way spontaneously, during the night. A young girl at the “Hospital Cochin," in consequence

of having taken freely of the sulph. quinine, became affected with amaurosis, which continued at the end of three weeks, notwithstanding appropriate and energetic means were employed for the restoration of her sight.

Dr. Rognetta, who claims for Rasori, priority in the use of quinine in acute rheumatism, "thinks, with the Italian physicians that the limits of tolerance should not be exceeded, and that beyond this, a species of poisoning may be induced, known by deafness, blindness, hallucinations, hæmaturia, &.''

Blindness, although not so common as the other effects, is not unfrequently produced, and may be prolonged for months or even years. It is not, however, generally known, that such may be the result of this medicine, when given in large quantities. The follow. ing are some cases occurring in this place and immediate vicinity, which show that when thus administered it may produce blindness more or less permanent.

Case Ist. Mr. P. of the town of Barry, Jackson co., was in the year 1840 attacked with a low grade of remittent fever, the nature of which was such, as to cause the attending physician to adıninister the sulph. quinine in large and frequent doses. Sixteen grains, (as judged by sight,) were ordered every hour, and continued until nearly one ounce was taken. Before the quinine was discontinued, he became perfectly blind, which, with a slow and gradual amendment, continued during the first year. Later than this, I have not been positively informed in regard to the case, but should judge, from what indirect information I have reeeived, that his sight is not yet perfectly restored.

Case 2d. Mrs. B., of the town of Concord in this county, was, a few years since, reduced so low by the endemic fever of the country, that her life was despaired of. As a last resort large quantities of quinine were given, and while taking it she became blind, which continued for several weeks. As she recovered her health the blindness gave way, and her sight was finally restored. Not being acquainted with the particulars of this case, I can give but these few general outlines.

Case 3d. P. M. Everett, of this place, was, in the autumn of 1843, attacked with remittent fever, and in a few days became so greatly reduced, as to leave but slight hopes of his recovery. Sulph. Quinine was therefore prescribed, in doses averaging three grains, every hour, and was continued for three days. In a short time, he becaine deaf, and soon after so blind that he could not see a burning candle, when placed immediately before his eyes. The blindness took place on the third day, after the commencement of the free administration of the sulph. quinine. Previous to this, and at this time, bis mind, (with the exception of occasional slight wanderings) appeared to be perfectly clear. After some weeks, his sight became partially restored, but continues more or less imperfect, even at the present time.

During the greater part of the first year, he could look steadily at

« SebelumnyaLanjutkan »