Cases in midwifery requiring manual & instrumental interference followed, in the former instance, first by trismus, then by hemiplegia of the right side; and ultimate recovery / by Charles Bell, M.D.

  • Bell, Charles, M.D.
Date:
1850
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Licence: Public Domain Mark

Credit: Cases in midwifery requiring manual & instrumental interference followed, in the former instance, first by trismus, then by hemiplegia of the right side; and ultimate recovery / by Charles Bell, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    into the uterus as far as the placenta, which was adhering to the fundus, and it required careful manipulation to separate it from its attachment. The uterus contracted regularly, and there was no hemorrhage. I afterwards ascertained that this patient had experienced difficulty in all her former confinements in the removal of the afterbirth. The case appeared to go on favourably for some days; but I was kept anxious by her pulse continuing about a hundred, and by her having little sleep at night. I therefore, as a precau- tionary measure, prescribed a febrifuge mixture,* and that she should take six grains of the compound ipecacuan powder at bed-time, to be repeated if she did not sleep. Even on the morning of the seventh day, when I was induced to make more presssing inquiries in regard to her symptoms, from her pulse being 110, she expressed herself quite free from all uneasiness. In the evening, however, after a full meal of porridge, she sur- prised her friends by moralising on her past life; and while they were endeavouring to compose her, she was suddenly seized with trismus. I saw her about an hour after the attack, when her teeth were clenched together, her eyes suffused, her face flushed, and she had a wild and frightened expression of countenance. She paid no attention to what was said to her; and when au attempt was made to give her some antispasmodic medicine, she turned away her face with a determined look, which gave rise to a doubt as to whether the jaws were closed by spasms or the will of the patient, such as we find in mania, to the puerperal form of which her case had some resemblance. This state con- tinued for upwards of six hours, when the spasm ceased, and she was enabled to swallow. She was ordered to have, while awake, every two hours, one table-spoonful of a mixture, con- sisting of three ounces of the camphor julep, three ounces of liquor of acetate of ammonia, and one drachm of solution of muriate of morphia. There was no return of the spasm, and the symptoms be- came very much the same as before the attack of trismus,-— there being little sleep, and the pulse continuing about a hun- dred and ten. On the afternoon of the tenth day after her con- finement, she had a severe rigor, which was followed by loss of speech, and paralysis of the whole of the right side, except of the face.-f- She was quite sensible to what was said to her, and Liquor of acetate of nmmonia, one ounce and n half; antimonial wine, fifty- five minims ; water, three ounces. To be mixed, and a table-siioonful of tiie mix- ture to be given every second hour. t The hemipicgiii in this case difTered in some respects from the usual form of that disease, as observed by Sir Gilbert Blanc, who states that it generally affects the left side and the face, as well as the extremities.—CyclojiiBdia of Practical ]Me- dicinc, Vol. iii. p. 252.