LEICESTER INFIRMARY.
1
346 that day. He improved for a few days, and then had another relapse, so that Mr. Power did an iridectomy up- wards, without chloroform, on Feb. 19th. Atropine was instilled, and a pad and bandage applied. It was dressed daily, and some atropine dropped in. He had no more pain, and on March 3rd his vision was t% with the right eye and a with the left. The vitreous was clear, and there was no sign of cupping. On March 5th it was still improving: V =}g with a convex 36 glass, and 20 without any glass, and he could read No. 4 Snellen with + 16. He has not been to the hospital since. CASE 3. Simple glaucoma; iridectomy.-Mary N-, aged sixty-five, married, with eight children, was admitted Jan. 15th, 1875. She stated that the sight of the left eye had been getting dim for nine months, occasional obscura- tions, lasting for a few minutes, coming on generally whilst at needlework. Her sight has been weak for the last twenty years, caused, she thinks, by suckling too long, and she has worn glasses during that time. Caught cold on Christmas day, and since then she had had severe pain in the eye and down the side of the face, accompanied by headache, and always worse at night, preventing her sleeping well. Very subject to rheumatic gout for years, all her fingers and toes being thickened and distorted at the joints. Her bowels have been very irregular for three years, generally constipated for days together. On admission there was no perception of light in the left eye; slight sclerotic congestion; iris greenish, immovable; pupil dilated; tension much increased; T + 2; vitreous too hazy to allow of examination of fundus; pain in eye acute, constant, and lancinating. Under chloroform Mr. Power performed an iridectomy upwards in the usual way. Atropine was instilled, and a pad and bandage applied. In the evening the pain was less than it had been for three weeks. Atropine was in- stilled daily, and she had no more pain. The tension was normal; the incision healed bycystoid cicatrix with con- siderable protrusion, which was somewhat lessened by a firm compress. She went out on Jan. 25th. On Feb. 8th the eye was in the same condition, but more tense than when she went out. She had had no more pain. There was still no perception of light, and the humours were too hazy to enable one to see the fundus. It was in the same condition on March 5th. LEICESTER INFIRMARY. DISLOCATION OF THE SIXTH CERVICAL VERTEBRA FORWARDS, WITH FRACTURE OF RIGHT TRANSVERSE PROCESS AND TIP OF LEFT TRANSVERSE PROCESS; FRACTURE ALSO OF BOTH LAMINÆ; DEATH ON THE SEVENTH DAY. (Under the care of Mr. BENFIELD.) ONE of the chief features of interest in the following case was the great variation in temperature, the lowest degree observed being 942°, the highest 106’4°, giving a range of 12-V. David W-, aged forty-six, a carpenter, was admitted on May 29th (at noon), 1875. The patient, who was a heavy man about 5 ft. 10 in. higb, fell from Blaby Bridge, a dis- tance of 25 feet, while removing iron bolts from sidings. On admission there was impaired sensation and mobility in both arms, complete loss of sensation from lower end of sternum (extending upwards three inches behind) to in- ferior extremities. He could not move the legs in the slightest degree, and tickling the feet did not excite any reflex action. The breathing was chiefly abdominal. The skin felt cold to the touch, and the patient complained of cold. Well-marked priapism. At 2.15 P.M (two hours and a quarter after admission) the temperature was taken, and found to be 965°. At 7.15 it was still below normal, but at 9.15 (twelve hours after injury) it had reached 992°. The temperature during the day had been as follows :-At t 2.15 r.nz., 96’5D; at 3 15,9460; at 4.15, 9560; at 5.15, 96 e; at 6.15, 97’20; at 7.15, 98°; at 9.15, 99 3°; at 10.15, 100 1°. At 10.40 r M. the pulse was 68, full; respiration 20. Patient complained of the arms being very painful-pins and needles sensation. Right wrist was swollen from severe contusion. The catheter was passed; not more than four ounces of urine in bladder. May 30th.-The temperature at 12 15 A M. was 100-40; at 2 15, lUl 2°; at 4.15, 1022°; at 8.15, 102 6; at 9.30,103’2°. At 9 30 A.M. the pulse was 96, full ; respiration 32. Face flushed and hot to feel; conjunctiva congested; skin of neck and ears also congested; carotids throbbing; tongue dry and fissured longitudinally. Patient was lying with arms semiflexed; if put straight, they soon assumed the flexed position. He could flex, but not extend, the forearm, but was not able to raise the arm from bed. No increased loss of sensation; had had no sleep during night.-10 AM.: Mr. Benfield visited patient, and ordered one grain of calomel every four hours, with ice-bag to spine. The tem. perature now began to fall suddenly. Thns, at 10.50 A.M., it was 1026°; at 1.15 P.M., 98 6°; at 3.15, 95 6°; at 4.15, 94-2°. The two armpits were now both taken, and with the following result: At 5.15pm.: right, 974°; left, 100’2°. At 6.30: right, 98 6°; left, 100°. At 7.30: right and left,100°. At 8 30: right and left, 100°. At 930 : right, 97 8°; left, 100’40. At 10.30 : right, 99’4°; left, 100°. At 1130: right, 100 2°; left, 100-4°. At 4.15 P.M.: Pulse 54; respiration 20. Loss of sensation had increased, and extended from third costal interspace. At 8.45 : Pulse 64; respiration 20. No extension of loss of sensation. 31st-The temperature at the armpits was as follows:- At 12 30 A.M. : right and left, 100°. At 1.30: right, 100 6°; left, 101°. At 2.30 : right, 1002°; left, 101-4°. At 3,30: right and left, 101’40. At 4.30: right, 100 8°; left, 101’2°. At 5 30: right and left, 1008°. At 6.30: right and left, 100 2°. At 7.30 : right and left, 100°. At 9: right and left, 100°. At 10.15 : right, 100-4°; left, 99 8°. Pulse 68; re- spiration 20; skin warm and dry. The temperature fluc. tuated during the day between 100° and 101°; but at 9 P.M. it was in the right axilla 101·6°, in i be left 105 ; at 10.30 it was in the right 101’20, in the left 100°. Thirty ounces of urine drawn off. On June lst the temperature was 98 6"; pulse 64, rather full; respiration about 20, but the patient was troubled with such incessant cough that it was impossible to count them ; the respiration, too, was almost entirely dia. phragmatic. No increase of loss of sensation. At 3 r.. the temperature was, right and left, 99 8°; at 9 P.M., right 996°, left 101’40. 2nd. -Temperature 996°; pulse 80; respiration 24. No material change in symptoms. A large quantity of ammo. niacal urine drawn off by catheter. Evening temperature: right, 98’4°; left, 97’20. 3rd.-Has passed a restless and delirious night; not more than half-an-hour of sleep. Pulse 92, full; respiration 28; temperature 102°. Has had several slight convulsive twitchings of the arms and shoulders; complains much of pain in the shoulders and legs. - 8.50 P.M.: Temperature of right armpit, 1028°; left, 104°. 4th.-Slept about an hour last night after a morphia hypodermic, 41 gr.; then was terribly restless and delirious.- 9.30 : Evidently sinking fast. Temperature 106-4,°.—11 A.M.: Death, just six days and two hours after receipt of injury. Autopsy.-Part of ligamentum nuchse and interspinous ligament between sixth and seventh cervical vertebrs riip- tured ; transverse processes of sixth bared of ligament. On separating sixth from seventh, which was readily done, the ligamentum subflavum was found to be ruptured, and cord exposed for fully half an inch. The transverse process on the right side was completely fractured, as were also both laminae. The tip of the transverse process on the left side was fractured. The cord was exceedingly soft and pulpy; unfortunately it was so destroyed in removing sixth vertebra that a satisfactory examination could not be made. NEWCASTLE-ON-TYNE INFIRMARY. (Cases under the care of Dr. BYROM BRAMWELL.) CASE 1. Left Hemiplegia; Double 01)tic Neuritis and Syphilitie Choroiditis; motor power regained before sensibility; con. vulsion; death; syphilitic tumour springing from dura mater; extensive softening.-R. S-, a man aged forty-one, was admitted on Nov. 12th, 1874, suffering from left hemiplegia. Patient had led a dissipated life for the past ten years; had been an opium-eater; had had syphilis. For the past year his sight had been failing. Three months ago he awoke one morning and found he had completely lost the
Transcript of LEICESTER INFIRMARY.
346
that day. He improved for a few days, and then hadanother relapse, so that Mr. Power did an iridectomy up-wards, without chloroform, on Feb. 19th. Atropine wasinstilled, and a pad and bandage applied. It was dressed
daily, and some atropine dropped in. He had no morepain, and on March 3rd his vision was t% with the right eyeand a with the left. The vitreous was clear, and there wasno sign of cupping. On March 5th it was still improving:V =}g with a convex 36 glass, and 20 without any glass, andhe could read No. 4 Snellen with + 16. He has not beento the hospital since.CASE 3. Simple glaucoma; iridectomy.-Mary N-, aged
sixty-five, married, with eight children, was admittedJan. 15th, 1875. She stated that the sight of the left eyehad been getting dim for nine months, occasional obscura-tions, lasting for a few minutes, coming on generally whilstat needlework. Her sight has been weak for the last
twenty years, caused, she thinks, by suckling too long, andshe has worn glasses during that time. Caught cold onChristmas day, and since then she had had severe pain inthe eye and down the side of the face, accompanied byheadache, and always worse at night, preventing hersleeping well. Very subject to rheumatic gout for years,all her fingers and toes being thickened and distorted atthe joints. Her bowels have been very irregular for threeyears, generally constipated for days together.On admission there was no perception of light in the left
eye; slight sclerotic congestion; iris greenish, immovable;pupil dilated; tension much increased; T + 2; vitreous toohazy to allow of examination of fundus; pain in eye acute,constant, and lancinating.Under chloroform Mr. Power performed an iridectomy
upwards in the usual way. Atropine was instilled, and apad and bandage applied. In the evening the pain wasless than it had been for three weeks. Atropine was in-stilled daily, and she had no more pain. The tension wasnormal; the incision healed bycystoid cicatrix with con-siderable protrusion, which was somewhat lessened by afirm compress. She went out on Jan. 25th.On Feb. 8th the eye was in the same condition, but more
tense than when she went out. She had had no morepain. There was still no perception of light, and thehumours were too hazy to enable one to see the fundus. Itwas in the same condition on March 5th.
LEICESTER INFIRMARY.DISLOCATION OF THE SIXTH CERVICAL VERTEBRA
FORWARDS, WITH FRACTURE OF RIGHT TRANSVERSEPROCESS AND TIP OF LEFT TRANSVERSE PROCESS;FRACTURE ALSO OF BOTH LAMINÆ; DEATH ON THE
SEVENTH DAY.
(Under the care of Mr. BENFIELD.)ONE of the chief features of interest in the following case
was the great variation in temperature, the lowest degreeobserved being 942°, the highest 106’4°, giving a range of12-V.David W-, aged forty-six, a carpenter, was admitted
on May 29th (at noon), 1875. The patient, who was a heavyman about 5 ft. 10 in. higb, fell from Blaby Bridge, a dis-tance of 25 feet, while removing iron bolts from sidings.On admission there was impaired sensation and mobility inboth arms, complete loss of sensation from lower end ofsternum (extending upwards three inches behind) to in-ferior extremities. He could not move the legs in the
slightest degree, and tickling the feet did not excite anyreflex action. The breathing was chiefly abdominal. Theskin felt cold to the touch, and the patient complained ofcold. Well-marked priapism. At 2.15 P.M (two hours anda quarter after admission) the temperature was taken, andfound to be 965°. At 7.15 it was still below normal, but at9.15 (twelve hours after injury) it had reached 992°. The
temperature during the day had been as follows :-At t2.15 r.nz., 96’5D; at 3 15,9460; at 4.15, 9560; at 5.15, 96 e;at 6.15, 97’20; at 7.15, 98°; at 9.15, 99 3°; at 10.15, 100 1°.At 10.40 r M. the pulse was 68, full; respiration 20. Patient
complained of the arms being very painful-pins andneedles sensation. Right wrist was swollen from severecontusion. The catheter was passed; not more than fourounces of urine in bladder.
May 30th.-The temperature at 12 15 A M. was 100-40; at2 15, lUl 2°; at 4.15, 1022°; at 8.15, 102 6; at 9.30,103’2°.At 9 30 A.M. the pulse was 96, full ; respiration 32. Faceflushed and hot to feel; conjunctiva congested; skin ofneck and ears also congested; carotids throbbing; tonguedry and fissured longitudinally. Patient was lying witharms semiflexed; if put straight, they soon assumed theflexed position. He could flex, but not extend, the forearm,but was not able to raise the arm from bed. No increasedloss of sensation; had had no sleep during night.-10 AM.:Mr. Benfield visited patient, and ordered one grain ofcalomel every four hours, with ice-bag to spine. The tem.
perature now began to fall suddenly. Thns, at 10.50 A.M.,it was 1026°; at 1.15 P.M., 98 6°; at 3.15, 95 6°; at 4.15,94-2°. The two armpits were now both taken, and with thefollowing result: At 5.15pm.: right, 974°; left, 100’2°.At 6.30: right, 98 6°; left, 100°. At 7.30: right and left,100°.At 8 30: right and left, 100°. At 930 : right, 97 8°; left,100’40. At 10.30 : right, 99’4°; left, 100°. At 1130: right,100 2°; left, 100-4°. At 4.15 P.M.: Pulse 54; respiration 20.Loss of sensation had increased, and extended from thirdcostal interspace. At 8.45 : Pulse 64; respiration 20. Noextension of loss of sensation.31st-The temperature at the armpits was as follows:-
At 12 30 A.M. : right and left, 100°. At 1.30: right, 100 6°;left, 101°. At 2.30 : right, 1002°; left, 101-4°. At 3,30:
right and left, 101’40. At 4.30: right, 100 8°; left, 101’2°.At 5 30: right and left, 1008°. At 6.30: right and left,100 2°. At 7.30 : right and left, 100°. At 9: right and left,100°. At 10.15 : right, 100-4°; left, 99 8°. Pulse 68; re-spiration 20; skin warm and dry. The temperature fluc.tuated during the day between 100° and 101°; but at 9 P.M.it was in the right axilla 101·6°, in i be left 105 ; at 10.30 itwas in the right 101’20, in the left 100°. Thirty ounces ofurine drawn off.On June lst the temperature was 98 6"; pulse 64, rather
full; respiration about 20, but the patient was troubledwith such incessant cough that it was impossible to countthem ; the respiration, too, was almost entirely dia.
phragmatic. No increase of loss of sensation. At 3 r..the temperature was, right and left, 99 8°; at 9 P.M., right996°, left 101’40.2nd. -Temperature 996°; pulse 80; respiration 24. No
material change in symptoms. A large quantity of ammo.niacal urine drawn off by catheter. Evening temperature:right, 98’4°; left, 97’20.3rd.-Has passed a restless and delirious night; not more
than half-an-hour of sleep. Pulse 92, full; respiration 28;temperature 102°. Has had several slight convulsive
twitchings of the arms and shoulders; complains much ofpain in the shoulders and legs. - 8.50 P.M.: Temperatureof right armpit, 1028°; left, 104°.4th.-Slept about an hour last night after a morphia
hypodermic, 41 gr.; then was terribly restless and delirious.-9.30 : Evidently sinking fast. Temperature 106-4,°.—11 A.M.:Death, just six days and two hours after receipt of injury.Autopsy.-Part of ligamentum nuchse and interspinous
ligament between sixth and seventh cervical vertebrs riip-tured ; transverse processes of sixth bared of ligament. Onseparating sixth from seventh, which was readily done, theligamentum subflavum was found to be ruptured, and cordexposed for fully half an inch. The transverse process onthe right side was completely fractured, as were also bothlaminae. The tip of the transverse process on the left sidewas fractured. The cord was exceedingly soft and pulpy;unfortunately it was so destroyed in removing sixth vertebrathat a satisfactory examination could not be made.
NEWCASTLE-ON-TYNE INFIRMARY.(Cases under the care of Dr. BYROM BRAMWELL.)
CASE 1. Left Hemiplegia; Double 01)tic Neuritis and SyphilitieChoroiditis; motor power regained before sensibility; con.
vulsion; death; syphilitic tumour springing from dura mater;extensive softening.-R. S-, a man aged forty-one, wasadmitted on Nov. 12th, 1874, suffering from left hemiplegia.Patient had led a dissipated life for the past ten years;had been an opium-eater; had had syphilis. For the pastyear his sight had been failing. Three months ago he
awoke one morning and found he had completely lost the
