Embed Size (px)
LIGATURE OF THE RIGHT COM-MON CAROTID ARTERY,
FOLLOWED BY HEMIPLEGIA OF THE LEFT
SIDE OF THE BODY.
A UTE number of Rust’s Journal containstwo examples of paralysis following ligatureof the carotid artery, an occurrence whichhad previously been observed by Baron vonGraefe and Sir A. Cooper.
CASE 1.—The first case was that of a man,49 years of age, affected with medullaryfungus of the palate. Various attemptshaving been ineffectually made to check or
extirpate the disease with mercury, Fowler’ssolution, the knife, and the actual cautery,it was resolved to try what effect mightresult from tying the common carotid artery.This was accordingly done on the right side without any difficulty or accident duringthe operation. Two hours afterwards thepatient began to complain of an unusualsensation in the whole of the right side ofthe head, attended with some difficulty ofdeglutition ; towards evening this sensation had disappeared, and was replaced by severepain in the left side of the head ; the dys-phagia had increased ; the face red ; thepulse equally frequent at both wrists, fulland hard. Eight ounces of blood weretaken from the arm, and an anodyne draughtexhibited. The symptoms continued with-out much alteration for a week, when, atthe morning visit, the surgeon found thepatient unable to move the left hand or foot.He immediately ordered more blood to betaken from the arm, and a purgative draughtto be administered. The paralysis continuedwithoutany modification. The ligature cameawa3 on the 28th day, but the size of thetumour in the mouth had not then under-gone any diminution; the reporter of thecase does not detail the treatment whichwas adopted at this period, but merely saysthat the man sunk and died on the 26th dayafter the performance of the operation. Onexamining the body the next day the arterywas found free from lesion, but several por-tions of the right hemisphere of the brain,including the centrum ovale, the ventricleand corpus striatum were excessivelysoftened ; the left hemisphere was freefrom lesion. The abdominal and pectoralviscera did not present anything worthy ofnotice.
CASE 2.—In this case the right carotidartery was tied for aneurysm of the innomi-nata, after Valsalva’s method had been triedwithout success. Half au hour after the
operation the patient began to feel a senseof lightness in the head, which soon termi-nated in severe pain extending across theforehead. Towards evening the headachincreased, the pulsations of the aneurysmal
tumour became more violent, and a tendencyto vomiting manifested itself. Twelve ounceof blood were taken from the arm and apurgative clyster thrown up. During thenight the patient continued to vomit, andcomplained of increased pain in the head,although the bowels had been freely eva.cuated. On the third day after the opera.tion symptoms of paralysis appeared in theleft side of the body, and the patient soonfell into a state resembling that produced byconcussion of the brain ; he was again bledto 8 oz., a blister applied to the i)eck, andan ice-cap to the head. These remedies had,however, no effect ; the respiration becomegradually more and more difficult, and thepatient died on the fifth day after the ope-ration.The body was examined on the following
day, but in this case no lesion of the brainwas discovered which could account for theexistence of paralysis ; the cavities of thechest and abdomen presented nothingabnor.mal.
EXTIRPATION OF THE OVARY.No. I. of the same volume contains a
paper on puncture and extirpation of thediseased ovary by Dr. Dohlhoff. There-sults of this practice were anything butfavourable.Two cases of sacculated dropsy, treated
by puncture, terminated fatally within afew days after the operation ; two othercases in which the ovary was extirpatedlikewise terminated in the death of the
patient.A third case is remarkable for its analogy
to one which excited no small share ofinterest several years ago in a northern
metropolis ; it is detailed with the utmostcandour by the author, who freely acknow,ledges the error of diagnosis into which he,as well as his colleagues, fell.
F. G., 23 years of age, was received intohospital on the 12th of November, 1835, forabscess in the neighbourhood of the knee-joint. After remaining some time undertreatment she became incapable of passingher urine, and the retention was so completeas to require the constant application of thecatheter. She now complained of pain in
i the lower part of the abdomen, and at thispoint a tumour become developed whichgradually filled nearly the whole of theabdominal region below the umbilicus,giving rise, in addition to retention of urine,to obstinate constipation. The latter wasso difficult to overcome that three drops ofcroton oil produced only a single stool, andthe same dose was repeated daily for fourdays without giving rise to a second evacua.
tion of the bowels.Various remedies were ineffectually triedup to the 10th September, 1836; the tumourof the abdomen continued undiminished.
and on a consultation being held, it wasdetermined to extirpate the u iseasea masswith the knife.On the 19th of September the author pro.
ceeded to lay open the cavity of the abdo-men, in the presence of his colleagues andptipils; the bladder having been emptiedby the catheter, an incision five inches in
length was made through the linea alba,and the hand introduced into the abdomen,but no tr,,ice of the tumour remained ; it haddisappeared while the operator was dividingtheabdominai integuments.
It is unnecessary to say that the wuundwas closed as quickly as possible, and thepatient carried to bed. On the day afterthe operation both the urine and faeces werepassed without any difficulty, and the
paticat had the good fortuue to recover inthe course of a few weeks.The author concludes this instructive
fdSe by declaring his opinion that what wasmistaken for diseased ovary was nothingelse than a spasmodic affection of the intes-tinal cn-ial, causing retention of gas andthus simulating the appearance of a tumour.
THE BLOOD.PROFESSOR MITSCHERLISCH has perforiiied
a variety of experiments for the purpose ofdetermining whether substances introducedinto the animal economy cause any appre-ciable change in the blood, but the resultsobtained have unfortunately been, for themost part, negative. He has, however,ascertained that most substances act onlv onthe globules of the blood when placed inimmediate contact with them; for if they aresuhmitted to the influence of digestion andabsorption they undergo certain changeswhich totally destroy their powers ; thusacetic acid, oxalic acid, ammonia, will notdissolve the globules, unless injected di-
rectly into the veins or arteries. Solutionsof the snlphate of iron, of sulphate of copper,sYhen introduced through the stomach, seemto exercise no influence on the blood, but ifmixed directly with the latter they produceau evident irregularity in the form of theglobules.—Müller’s Arch. and Arch. de Med.,July. -
SUDDEN DEATH.IN a memoir on the causes and frequency
of sudden death, M. Devergie analyses fortycase3 which he had observed, and shows,contrary to the vulgar opinion, that apo-plexy is much less freqnenUy the cause ofsudden death than is imagined ; of theforty cases only one was produced by apo-plexy. Pulmonary congestion is a muchmore frequent cause; this has been observedby M. Devergie in twelve cases singly, andin tttetve others combined with congestionuf the brain. Finally, he assetts, thats)ncope may terminate in death, withouttbeoccarrence of any organic lesion.—Arch.de illed., 3 u ly, 1838.
DANGER OF MANUFACTORIESEMPLOYING ARSENIC,
TO THE NEIGHBOURING POPULATION,
DottrHC a space of thirty years that amanufacturer of coloured paper had been inthe habit of preparing his colour with mine-ral substances, several families who inha-bited the next house to the manufactory,were affected with vatiotis symptoms, suchas pain in the head, constant colic, (liar-rhœa, tumefaction of the limbs, &c. ; andmany members of those families died fromtime to time, with the above symptoms.Several other persons having fallen victimsto the same disorder it was suspected thatthe water of the well from which the inhabi-tants of the house were accustomed to drinkmight have been poisoned by some of themineral substances employed in the manu-factory, and two well instructed chemistswere ordered to examine it, but could findnothing of a deleterious nature. The peopleof the house, therefore, took courage, andcontinued to use the water until symptomsof poisoning set in with such violence as toleave no doubt as to the cause of the illnessproduced. A deep cut was now made ina cellar belonging to the manufacturer (andnot far from the well), and this cut soonbecame filled with water from the court-
yard of the manufactory. Several quarts ofthis water were evaporated, then filtered,and the residue tested with hydrochloricacid, but no remarkable effect was produced.The cause of the error was now manifest.
The arsenic was contained in the earthy resi-due which remained on the filter; this was,therefore, re-examined, and found to con.tain a remarkable quantity of arsenic.—Jour,de Phamrx...Tulv. 1838.
ANTIDOTE AGAINST ARSENIC.WE have already given an account of the
experiments made with the hydrated per-oxide of iron, as an antidote for arsenic, andtheir results. The following is a remark-able example of the efficacy of this means.
A baker finding the food prepared for hispigs was devoured by the rats, mixed up 4oz.of arsenic with a quantity of flour and placedin the troughs, having previously locked uphis two sows in a place of safety. The ani-mals, however, having broken open the door,eat up the whole of the flour, and were imme-diately seized with symptoms of poisoning.Two medical gentlemen in the aeighbour-hood being made acquainted with the cir-cumstance, mixed up from two to threepounds of the peroxide with water andflour, and gave it to the pigs, who drank
with avidity about one half, but refused totake the rest. The animals were now laid,upon the ground, and apound of the antidote