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most likely the catamenia, accompanied, as they sometimes are, by hemorrhage. It is probable that she became pregnant in November, and quickened in March; the latter occurrence being attended by a disposition to miscarry. The immense discharge of fluid evinces the ample provision made by nature to guard the conception from pressure. These large watery discharges not unfrequently occur during pregnancy, without being followed by the expulsion of the contents of the uterus, but their source does not seem to be clearly ascertained. By some it is thought that a portion of the decidua is separated from the surface of the uterus, from which the discharge is secreted. Others suppose that a collection of fluid may take place between the chorion and amnion, forming what has been called false waters. It has also been asked, whether it may not be a portion of amniotic fluid escaping through a slight fissure of the amnion, some distance above the os uteri, and then the farther egress be prevented by a contraction of the uterus. But, whatever theory may be formed on this point, it is a practical fact, that if moderate care be taken of the patients, they will frequently complete the full period of utero-gestation without any apparent detriment to the foetus.
The indications for the treatment of patients under these circumstances appear to be, 1st, to remove all causes of excitement, whether general or local; 2dly, to tranquillize the system; 3dly, to keep the patient in a state of perfect rest, and in the horizontal posture, while the least discharge remains.
Mrs. Scott became pregnant again, and, having passed through the period of pregnancy without any untoward occurrence, was delivered of a healthy girl, June 9th, 1827.
CASE II. Tedious Labour, from Adhesions in the Vagina. August, 1828. Hannah Ellis, æt. nineteen, of a delicate constitution, states that she was delivered of a still-born child thirteen months ago, by means of instruments, in consequence, it would seem, of defective uterine action; for she says, that, after having been in labour four days, the pains became too feeble to expel the child, and that it was then extracted with the forceps. Inability to retain the urine, and great soreness of the vagina, subsequently came on; the first continued for a few days only, the soreness for several weeks; at length she began to feel some obstruction, or what she calls "a lump,' in the vagina, which made intercourse difficult, though it yielded a passage to the catamenia. About five months after her delivery, notwithstanding the above circumstances, she
fell pregnant, and from that time to the present she has suffered more or less from great pain and soreness of the vagina, with leucorrhoeal discharge; these symptoms have been latterly conjoined with an oedematous state of the labia.
August 9th. This morning she was attacked with slight pains in the loins, which may have been brought on by intestinal irritation, as she is labouring under diarrhoea, accompanied with griping and tenesmus. On making an examination per vaginam, the finger was obstructed about two inches from the os externum, by a firm unyielding substance, or strong membrane, completely impervious, except at the lower part, where these seemed to be a small aperture, with a thin edge, not capable of admitting the point of the finger. This obstruction was in all probability produced by cicatrization of the sides of the canal, the result of injury inflicted on its membrane by the instruments, or by the long impaction of the head in the pelvis during her last labour. There was a profuse muco-purulent discharge, and the vagina, particularly at the obstructed part, was so exquisitely sensitive, that the patient would scarcely submit to an examination.
Opiates were given to allay the intestinal irritation, and fomentations applied to the pudenda.
August 11th. The diarrhoea has ceased, but since the 9th she has been harassed with slight but frequent pains in the loins. This morning the membranes broke, and the pains have left her; she has ceased also to feel the movements of the child. The uterus has evidently subsided. On examination, the obstruction was found unaltered, and no presentation could be discovered.
August 14th. There has been no recurrence of pains since the 11th; they are now returning, but are feeble, frequent, and ineffective.
August 15th. The pains towards the evening became more forcible, and a discharge of blood was observed. The vagina is rather more relaxed. The patient is exhausted from the long continuance of the short and fruitless pains. An opiate was given, and more nourishing diet allowed.
16th. The pains are now more protracted, and attended with a slight sense of bearing down. On examination, the head was found presenting through the thick membranous adhesion of the vagina, which is exceedingly painful. At four P.M. the head was still resting on the obstruction: the pains were short, and the bearing down inconsiderable. At seven P.M. the head was suddenly protruded, though there had not been much increase of pain, and she was delivered of a still-born male child. Whether the adhesions were rup
tured or dilated was not ascertained, as the expulsion of the head took place during the absence of Mr. Prout, the gentleman attending her, to whom I am indebted for the report of the case.
She recovered well, and was seen by Mr. Prout for several weeks afterwards, but refused to have any means used to effect the dilatation of the part.
Cases of this kind sometimes occur from inattention to the parts after the use of instruments, and sometimes even after a severe natural labour.
To the Editor of the Medical Quarterly Review.
SIR: Not being aware that colchicum has ever been used as the principal remedial agent in the treatment of erysipelas, I am induced, through the medium of your excellent work, to communicate to the profession the result of some cases so treated, that have come under my actual observation. Its mode of action is the question; its efficacy is indubitable. The relief derived from colchicum in rheumatic and gouty affections is generally accompanied with nausea, sometimes vomiting, griping, and a copious and frequent discharge from the bowels. Such, however, is not invariably the case, as many of the most rapidly decisive cases of the two latter affections terminating successfully that I have witnessed have been wholly unattended by any symptom of the kind. How then is its action in erysipelas to be accounted for? In my opinion, principally through the medium of the arterial system; and for the following reason.
I have upon all occasions observed the subsidence of erysipelatous inflammation accompanied by an equal diminution in the force and frequency of the pulse, which becomes soft and regular, without any jerking or intermission whatever. Such being the case, I can readily conceive why, the heart's action being subdued, a proportionably small quantity of blood is propelled into the capillary arteries, and a relative diminution in the cuticular inflammation is the result.
Bleeding has also been recommended and practised by many of the most eminent men in our profession in the acute inflammatory stage, and acts in the same manner as colchicum by lessening the vascular excitement, while the latter possesses a peculiar influence in controlling the most violent disturbance of the arterial system, without at the same time encroaching on the restorative powers of the system; the former in accomplishing this purpose produces a tendency to a train of low typhoid symptoms, from which it is often impossible to
rescue the patient, even with the aid of external heat and the exhibition of internal diffusible stimuli; consequently, it becomes a great desideratum to know by what means we can safely combat the intense burning heat, redness, pain, tumefaction and inflammation supervening on an attack of erysipelas without incurring the risk of running into the consecutive typhoid stage; and this object can be safely and surely obtained, I have no hesitation in saying, by administering colchicum in properly regulated doses. In confirmation of these views, I will now lay before you the cases before alluded to.
R. Berry, ætat. twenty-eight, admitted November 21, 1833, with rheumatism. On the 22d his scrotum became very highly inflamed, oedematous, and enlarged to the size of a child's head. He had been previously well purged. Several veins in the scrotum were opened with a lancet, and bled freely into a warm linseed-meal poultice.
23d. Swelling of scrotum very much increased, erysipelatous inflammation extending down both thighs up over the abdomen and left side of the face and neck; skin of a scarlet or crimson hue; smart burning heat; pulse 140; tongue dry and very white; bowels open; great thirst.
Four P.M. R. Pulv. Colchici, gr. xv.; Sodæ Carbon. 3i. M. ut ft. pulv. statim. sumendus.
In about a quarter of an hour, the frequency of pulse, redness, and burning heat of skin very sensibly diminished, and the patient at the same time said that he was cooler and much more comfortable. At the expiration of an hour, the heat and crimson hue of the skin, the frequency and fulness of pulse augmented considerably.
Five P. M. Pulv. Colchici gr. x.; Sodæ Carbon. ij.; M. ut ft. pulv. statim. sumendus.
This dose was followed by effects as beneficial, but more lasting, the efflorescence and other symptoms not recurring so rapidly or in so aggravated a form. It was necessary to repeat the last powder at seven o'clock. This had the desired effect of thoroughly subduing the frequency and fulness of the pulse, the heat and redness of the skin, and swelling of
These large and frequently repeated doses of colchicum so rapidly and decidedly reduced the action of the pulse, that it became an imperative duty to watch its effects with the most scrutinizing attention, and delay the exhibition of another dose till a tolerably well established reaction took place. To watch the ebb and flow of symptoms between the intervals of giving the colchicum was both highly interesting and satis
factory; for, in the short space of five or six hours, the patient was restored to a perfect state of health.
25th. The swelling, together with the redness of the scrotum and face, had nearly subsided, the skin was cool, tongue clean, pulse eighty, soft. R. Acid Hydrocyanici dil. m. ij.; Vin. Colchici, m. xv.; Aquæ 3i.; M. ut ft. haustus, tertiis horis sumendus.
On the morning of the 26th not a vestige of erysipelas remained.
II. Charles Mace, æt. nineteen, admitted November 29th, with great determination of blood to the head, and generally plethoric habit, was much relieved by active purgative medicines. December 9th, complains of sore throat; face much flushed.
Dec. 10th. Much pain, great tumefaction, and high erysipelatous blush over the nose and round the orbits; had but very little sleep the night previous, owing to the burning heat of his face. Pulse 108, tongue furred, bowels open from previous medicine.-The face was covered with flour. VS. 3xij. Vin. Sem. Colchici, 3ij.; Soda Carb. zss.; P. Rhæi, 3ss.; Mist. Camph. 3viij. 3j. ter die.
11th. Erysipelas spreading; pulse ninety-four, hard. The blood was cupped.-Rep. mist. quartis horis.
12th. The tumefaction was so much increased, that the palpebræ are nearly closed; heat of face much increased; pulse ninety-six.-Ömitt. mist. Soda Carb. i.; P. Colch. gr. v. quartis horis.
13th. Erysipelas is receding from the nose and eyes, but spreading over the cheeks; pulse ninety, soft.-Rept. pulv. secundis horis. Hirudines xij.
14th. Efflorescence is disappearing fast; pulse ninetytwo, soft.-Soda Carb. et Acid. Tart. in statu effervesc. p. r. n.
16th. The erysipelas is disappearing very fast; pulse ninety, soft.-Omitt. Pulv. Colchici.
17th. Quite free from erysipelas; pulse ninety-six, soft; skin dry.-Baln. tepid. Port wine živ., mutton chop daily. 19. Continue chop and wine. Dec. Cinch. 3j. ter die. 24. Omitt. Vin. Lusitan. Two pints of porter daily. Quin. Sulph., Ferri Sulph. aa gr. xvj.; Acid. Sulph. d. 3j.; Mist. Camph. viij. 3j. ter die. He only complains of weakness.
30th. Dismissed, perfectly well.