Gambar halaman

and feces were passed involuntarily. The pulse was feeble and intermittent.

Wet cups to chest and back of neck were used, without giving any relief.

Post-mortem twelve hours after death. On removing the calvarium the membranes of the brain appeared congested. The dura mater being pierced, about eight ounces of serum poured out. In the right hemisphere anterior lobe was found the tumor, about the size of an egg, and round as seen in the specimen, between the dura mater and arachnoid, and was attached to the bony excrescences of the calvarium, and adhered to the dura mater. The lungs were normal, as also the heart, liver, etc.

SYNOVITIS OF KNEE-AMPUTATION OF THigh-DEATH.—Dr. T. C. Finnell presented a specimen of disease of knee-joint implicating the bones—amputation of thigh-death. The patient, a young man, æt. 19, two years since injured the knee-joint. Synovitis followed, which terminated in suppuration of the joint. When seen by Dr. Finnell, he was very much reduced. A consultation was held, and removal of the limb advised. This was done, and every thing went on well until within the last two weeks, when the discharge increased in quantity, and he sank and died.

On inspection, the heads of the femur, tibia, and patella are seen to be eroded. The joint was destroyed by the abundance of pus in the surrounding parts. The patient had no evidences of lung disease.

PERFORATING ULCER OF STOMACH.—Dr. Finnell then presented an instance of perforating ulcer of the stomach, occurring in a young woman 18 years of age. For the last eighteen months she complained of pain in the stomach and abdomen, but still was able to attend to her duties as servant, until four months since, when, her strength failing, she was obliged to leave off work. Returning home to her friends, she was still able to be about, complaining of general weakness and severe palpitation. She continued in this way until two days ago, when she was suddenly seized with a severe pain in the abdomen and head. dually became comatose and died.

Autopsy this afternoon. Body not much emaciated. The skin was of a peculiar light yellow color. On laying open the abdomen, the stomach was found in a puckered condition at its lesser curvature, where was situated a perforating ulcer-adhesions having taken place between that part of the stomach and liver, thereby preventing general peritonitis.

WOUND OF RIGHT VENTRICLE.—Dr. Hutchinson exhibited a specimen illustrating wound of the right ventricle. The man from whom this was taken received a wound from some sharp instrument, this day week. The external wound was situated two inches within the left nipple, within about half an inch of the sternum, passing downward, backward, and inward towards the sternum. He ran out of the house in which he was stabbed, some fifteen paces, fell, and expired after the lapse of twenty minutes.

The post-mortem was made by Dr. Geo. Cochran, to whom he was in

She gra

debted for the specimen. The pericardium was filled with semi-coagulated venous blood.

Dr. Dalton observed, that twenty minutes is a long time to live after the reception of such a wound. It occurred to him to inquire whether such a wound in the left ventricle would not be followed more speedily by death, than in the right side. He believes that there are no instances of aneurism of the ascending arch bursting into the pericardium, in which death does not occur instantaneously.

In both cases it seems to be owing to the arrest of the heart's action. The delay in this case seemed to him remarkable, and he asked if any of the members had seen a similar case.

Dr. Hutchinson referred to a paper upon this subject, published some time ago by Dr. Purple, in which death in some of the cases related was even longer delayed. In one case it was six or seven years, caused by a shot in the right ventricle.

Dr. Dalton.—In these remarkable cases was there a free opening between the cavity of the heart and pericardium?

Dr. Hutchinson.-In one case the wound cicatrized, and the patient died of some other disease.

Dr. Dalton.—That may be the case when the wound is oblique, by which means a valve is formed, which closes up the opening completely. He noticed this in the lower animals quite often, where a wound fiveeighths of an inch long was going to be closed up in this way.

Dr. Thomas referred to a case that came under his observation six years ago, in Charleston. Two young negrocs got into a difficulty; one stabbed the other in the chest. The man who was struck said he was killed, and sat down in a chair; afterward he walked a quarter of a mile before he dropped down dead. The direction of the wound was oblique.

Dr. Dalton.-Was the wound sufficiently oblique to account for the delay?

Dr. Thomas. — The physician accounted for it in that way. He recollects a case that was presented to the Society by Dr. Van Buren some time ago. A man in the New York Hospital received a wound in the heart from a bayonet, and lived nearly a week after. He died suddenly.

Dr. Dalton believed in that case the wound could not have passed entirely through the ventricle, but only through about two-thirds or three-fourths of its substance, and that afterwards the remaining part gave way.

Dr. Hutchinson.—In the paper to which I referred it is said that the wounds of the left side of the heart are less speedily fatal than those on the right-owing doubtless to a peculiar arrangement of the muscular fibres of that side.

Dr. Peaslee.-It seems to me that there are two or three elements to be taken into account. In the first place, if the artery is ruptured at the commencement of the ascending aorta, the blood there is poured through an opening which has no contracting power. At every contraction of the left ventricle, the blood will be very sure to find its way

through the opening. If of any considerable size, it must very soon fill it up; but if the wound is oblique, as Dr. Dalton suggested, the very contraction of ventricle might close up the wound. It seemed to him this might be the case, even if not oblique. The force of contraction might be sufficient to close it. In the right ventricle the case is different; in fact, sometimes we can hardly tell whether the wound is oblique or not, the walls are so thin. This question is certainly of very great importance in connection with the murder of Dr. Burdell. According to some it was considered impossible that he should with a wound of the heart have arisen and walked to the door, although there were evidences of this fact in the spots of blood upon the floor, against the door, and on the ceiling This is one of the facts that would go to show that it was possible.

TUBULAR PREGNANCY.—Dr. Hutchinson next exhibited a case of tubular pregnancy. It occurred in a female thirty years old. She was the mother of three children. At 5 o'clock the other afternoon she was taken with fainting-spells; she supposed herself three months pregnant, and was seen by a physician soon afterwards, who found her vomiting, etc. She remained in a fainting condition during the night, and was in that state at eight o'clock in the morning, when he saw her. She had a blanched appearance, her extremities were cold, and there could be felt no pulsation at the wrist. Did not complain of any pain, though towards the last there was some tenderness of the lower portion of the abdomen. She died soon after.

Autopsy eight hours after death. We supposed she had died from hæmorrhage following rupture of the right Fallopian tube. We could not refer it to any other cause. We found, on laying open the abdomen, a quart of blood in the cavity of the peritoneum, and a rupture of the right Fallopian tube at about its middle portion. It can be seen enlarged considerably at the place where the fætus was situated. The cord was hanging through the opening into the Fallopian tube, and also the umbilical vesicle. A corpus luteum in right ovary is very distinctly marked.

Dr. Finnell presented a somewhat similar case to the Society some time ago, removed from a prostitute. It was situated in the right Fallopian tube, also. She died of internal hæmorrhage. The amount of blood effused was very great; the whole abdominal cavity seemed to be filled with it. The fætus was enclosed in a large sac; the amniotic fluid was as clear as water. The fætus was a little larger than the one here presented. She was said to have been delivered of a child at full term; if this were true, there would have been double pregnancy, one in uterus and one in the Fallopian tube.

ABORTION HYDATIDS.—Dr. Johnston presented portions of the product of abortion. The lady from whom this was taken, aged thirty-five, had two children living, between whom she had a miscarriage, about three and a half years ago. On the first of January last, she supposed herself three months gone.

After attempting to lift a sick friend she was seized with flooding: this was soon checked. She, however, about two weeks after, felt life very evidently, and for three weeks after was free from flooding, until about two or three weeks ago, when hæmorrhage

recurred. Since then she has passed blood several times. Notwithstanding all this she said she felt life, and it was hoped she would get through. On the morning of the 23d Dr. J. was called about four o'clock. The patient had suffered pain all night, and was bleeding pretty freely. By the time he reached the bedside flooding had ceased; pain was intense; pulse 120. Her skin was warm, and she seemed to feel strong, but she had lost a great deal of blood. The pain in the abdomen and loins was so intense that he could not make an examination. About eight o'clock this mass came away. He found it to be hydatids, about a pint and a half in quantity. He presented the specimen in order to ask if this state of things could not be diagnosticated at an early stage, and thus save a vast amount of trouble and annoyance.

Dr. Finnell remarked that he had made an autopsy of a lady whose history was somewhat the same as in this case. She supposed herself pregnant about three and a half or four months. Flooding came on after exertion. It was very profuse and alarming. Several medical men were in attendance, waiting for the expulsion of the child; a large amount of hydatids made their appearance. These were not suspected to exist up to the moment of delivery. She died a week after, with pneumonia.

Dr. Sabine asked Dr. J. if there were any frequent gushings of water. He had two cases of that sort in which this symptom occurred. He believed this to be one of the symptoms.

Dr. Johnston.--The only gushes she had were pure blood.

Dr. Peaslee thought it a point of some interest whether such a production is to be regarded as a product of conception.

Dr. Clark did not have much doubt about it. He thought it pretty fairly settled in the affirmative, inasmuch as it can be formed of nothing but the chorion, and the chorion can be formed of nothing but the fætus.

CANCER OF SPINE.—Dr. H. B. Sands exhibited an instance of encephaloid disease of the spine. The particulars of this history are somewhat incomplete, but are as follows: This patient sprained his back in attempting to lift a heavy piece of timber, in June last; the only evil consequences at the time were the passage of bloody urine and a certain amount of lameness. He continued to work, occasionally suffering pain, until December last, when he was obliged to leave off work. Two physicians were at that time called to see him, and found him suffering from acute meningitis of the cord. He was prescribed for accordingly, and the disease abated in severity, but still he was unable to resume bis occupation, and he remained confined to his room until two weeks ago, when, in attempting to go to the water-closet, he was seized somewhat suddenly with paraplegia. Previous to this time he had no paralysis, but a severe pain in the lower extremities. He remained paraplegic until his death, which was a consequence of exhaustion.

AUTOPSY.--The portion of spinal cord two inches above, and including the cauda equina, was shown.

There was nothing abnormal except a very beautiful vascularity of the parts. Within the theca was a very large accumulation of serum, which distended the canal and made pressure upon the cord. The bony walls presented a marked appearance of disease, the disease being confined to



the sacrum and lumbar vertebræ, most marked in the former. The bones were softened, yielding to the pressure of the finger-nail; the softening affected the bodies; they were porous, and infiltrated with a fluid looking like the mixture of blood and pus; but under the microscope no pus was discovered, but cells mostly round, about jouo or boo of an inch in diameter, each having a nucleus from

4000 5100

of an inch in diameter. Besides, there were free nuclei that looked very much like globules of pus, but they did not dissolve on addition of acetic acid. The microscopic appearances agree with those noticed in encephaloid disease at this point. There was also fungous growth in the duodenum, colon, and also at the neck of the bladder. What makes it probable that the disease was malignant in spinal cord was, that the appearances of the growths elsewhere had the same characteristics. The kidneys were not known to be diseased; they furnish very pretty specimens of granular degeneration. The left is very large and right very small. The microscopic appearances are those usually met with in Bright's disease.

FATTY DEGENERATION OF THE HEART.—Dr. E. R. Peaslee presented a case of fatty degeneration of the heart. The patient, a cook, æt. forty, was attacked very suddenly last Friday morning, and he was sent for in great haste. She had intense pain in the epigastric region, and in the abdomen generally; had vomited several times, and had a few discharges of a watery character. On examining the contents of the stomach, large masses of meat were discovered. She had been eating a large quantity of fresh pork, which she remarked always was accompanied with unpleasant effects. It seemed to be merely irritation of the stomach from the presence of this food. She had no tenderness on pressure. Her pulse was rather weak and slow, which he attributed to the intense paroxysms of pain. He directed ten drops of laudanum to be given, and fomentations to the abdomen until the pain should go off. He also ordered a powder of rhubarb and perchloride of mercury for the pain, and expected to see her well in the course of a couple of hours. He was again sent for two hours afterwards, when they said she was dying. She died at one o'clock.

AUTOPSY.-He suspected arsenic in the stomach. No cause of death was found, however, except as seen in this heart. The heart appears to be perfectly well to the naked eye, but, examined by microscope, is exceedingly fatty. The stomach was congested, and contained about an ounce of blood. The case is interesting in relation to the sudden death and its cause.


SOCIETY AT ITS OCTOBER MEETING, 1858. The Nashville Medical Society held its fifth regular meeting on Wednesday, October 6th. Vice-President, Dr. S. S. Mayfield, in the chair; Dr. Blackie, Secretary.

« SebelumnyaLanjutkan »