Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner.

Date:
MDCCCXLIX [1849]
Catalogue details

Licence: Public Domain Mark

Credit: Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner. Source: Wellcome Collection.

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    lour and consistence. The pain, which had returned as bad as ever, had now en¬ tirely ceased, and excepting a sense of a great weakness, she felt quite well, and wanted food. During the next forty-eight hours she passed three or four motions, consisting chiefly of the same black mat¬ ter, but there was no return of sickness. She gradually recovered, to a consider¬ able degree, from the state of faintness, enjoyed her food, wanted to sit up, and remained free from pain. During the last night of her life, she slept comfortably, and awoke at five in the morning with sick¬ ness. She vomited about eight ounces of fluid arterial blood, and immediately ex¬ pired. Her death took place ten days from the date of the accident, and forty-eight hours from the commencement of syncope. An examination was readily obtained, which cleared away all doubt as to the nature of the case. The stomach was dis¬ tended by an immense coagulum of fluid blood, recently effused. The colon was distended in like manner throughout the whole of its extent, by the same kind of black treacly matter which had passed during life, evidently blood acted upon by the intestinal acids, and probably effused some time before. The small intestines were free from blood. Not the slightest lesion, nor any morbid appearance, could be detected in the stomach or bowels. On slitting up the cesophagus, an opening was observed through which a probe could be passed into the descending aorta, an inch below the left subclavian artery, the oeso¬ phagus and aorta being close together. The opening was the third of an inch in length, with torn and irregular edges. The wound of the aorta was smaller, and situated rather lower, so as to make the communication somewhat valvular ; on the opposite side of the oesophagus was an abrasion of the mucous coat, evidently caused by local injury. Thus, then, the cause of death was suf¬ ficiently manifest. It was clear that a wound had been made by some foreign body lodging in the oesophagus, and per¬ forating the aorta through it. On care¬ fully examining the contents of the sto¬ mach and bowels, a small piece of bone was found, which I have little doubt was the cause. It was thin but strong, of an irregular outline, half an inch in length, andaquarter of an inch wide at the centre, becoming narrower at each end. It had been probably longer and more pointed originally. In his remarks on this case, Mr Mor¬ gan discusses the question as to the pro¬ priety of the introduction of the probang in such cases. He concludes that, in a case where the body is known to be hard and sharp, it is better practice not to endeavour to use the probang, when it has reached low down, so as to be out of the reach of the finger or extracting instruments. [A case, in some respects very similar to this one, was related by Dr James Duncan, in 1844, in the Northern Journal of Medicine. The foreign body—a couple of false teeth, fitted in a sharp projecting plate— was arrested at the same part of the oeso¬ phagus, but appeared to have descended into the stomach. Nine days afterwards the patient died from hemorrhage ; and, on dissection, the aorta was found to be perforated about half-an-inch below the origin of the left subclavian. We refer to Dr Duncan’s interesting paper for a notice of a number of cases of arrest of foreign bodies in the oesophagus, and ob¬ servations on the treatment and termina¬ tion of such cases.] 316.—Foreign Body in the Rectum.— M. Velpeau related at the last meeting of the Academy of Medicine, a curious case of this kind which had presented itself to him in the morning. A man was admitted into the hospital with a tumour, which projected under the false ribs on the right side. It was easy to trace the form of the tumour through the walls of the ab¬ domen, and the patient confessed that it was produced by a long Eau de Cologne bottle, which he had introduced into the rectum. Although the story appeared so extraordinary, it turned out to be true ; for the neck of the bottle was easily felt on passing up the finger ; it was then seized, and the whole bottle extracted with facility. It was twenty-eight centi¬ metres in length, and as the foreign body disappeared, so did the tumour of the side; in fact, it was impossible to doubt that the tumour depended on the projection of the bottle. The patient felt no inconveni¬ ence after the extraction of the substance; but it seems strange that any inflexible body could penetrate so far, without pro¬ ducing any lesion whatever. — Medical Times, September 8,1849. 316.—Large Noevus of the Lower Lip removed by Ligature. Reported from Lon¬ don Hospital.—January 4,1848. William Fletcher, a bricklayer, aged twenty-three years, was admitted into the London Hos¬ pital, under the care of Mr Luke, desiring to be relieved of the incumbrance arising from an immensely enlarged lower lip, caused byantevus, which had existed from his earliest recollection.