ST. BARTHOLOMEW'S HOSPITAL.
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393 ureter, which in some positions exactly closed it, and had, no I doubt, obstructed the flow of urine down it. Peter C-, aged twenty-five, admitted on Nov. 26th, 1859, under the care of Dr. Page. He worked at a baker’s. On the evening before admission he said he had gone to bed perfectly well; he awoke about one o’clock in the morning with pain in his throat. At three he arose, as was his custom, and worked till six. At that time he was suffering greatly from dyspncea. This continued until half-past nine, when he was brought to the hospital. He was blue, struggling for breath, and apparently at the point of death. Mr. Hammerton at once gave an emetic-dose of tartarized antimony, and bled him to the extent of eighteen ounces. The emetic acted well, and the bleeding very greatly relieved him. He then had two grains of calomel every four hours. When he was seen at noon, he way lying quietly, with a pale face, free from duski- ness, and with ruddy lips. The breathing was free from dis- tress-32 in the minute; the pulse 104, soft. He still com- plained of pains about the larynx. The voice was low, but not obviously unnatural in tone. The blood was neither cupped nor buffed. He was now seen by the physician, and laryn- gotomy was suggested; but, on consultation, it was considered that the case was not sufficiently urgent to warrant the ope- ration. He was visited in the evening by the physician, who found him tranquil and easy, with no sign of venous blood in the colour of the face or lips, a good pulse, and apparently in a promising state. He had a short time previously had a short spasmodic attack of dyspnoea. About ten minutes after this, just after having expressed himself better, and got out of bed without help, he was suddenly seized with extreme shortness of breath, turning blue, and struggling for air. The house- surgeon was in the hospital at the time, and the trachea was opened as soon as possible, and before the pulse ceased; but he never breathed afterwards. Examination twenty hours after death.-The body was in good condition. There was the mark of venesection on the right arm, and the blood being very fluid a large quantity had run out of the wound (which was quite recent) after death. The fauces and pharynx were quite healthy. There was very great oedema of the aryteno-epiglottidean folds, and of the whole cellular tissue, as low down as the true vocal cords. The edges of the ventricle of the larynx were brought into close apposition by the swelling, and mucous fluid, of a milky appearance, exuded from the sacculus on pressure. Below the true vocal cords there was no effusion whatever; but the mu. cous membrane was somewhat reddened. There was an in- cision into the upper part of the trachea, just above the right lobe of the thyroid body, which would easily admit the passage of the index-finger. There were pleural adhesions of the right side of the chest. All the viscera were healthy. ST. BARTHOLOMEW’S HOSPITAL. ŒDEMA OF THE GLOTTIS, SUDDENLY SUPERVENING IN THE HOSPITAL, IN A CASE OF JAUNDICE FROM OBSTRUCTION IN THE HEPATIC DUCT. (Under the care of Dr. FARRE.) IN addition to the two cases of dropsy of the glottis which we noticed in St. George’s Hospital, the preparations of which we also had the opportunity of examining in the museum, through the kindness of Mr. T. Holmes, the curator, another striking example came under our observation at St. Bartholomew’s, of which the following is a very brief outline :- Thomas C-, aged forty, was admitted October 1st, 1859, with icterus of five weeks’ standing. He had all the usual symptoms consequent upon this: clay-coloured stools; sick- ness ; skin of a universal deep-yellow tinge, which extended to the conjunetivse. He was submitted to mercurial and other treatment with but partial benefit, after which ox-gall was given with decided advantage for a time, and then discon- tinued. The mercurial treatment was abandoned on account of the debility which it produced. On the 28th of November he was ordered gentle applications of electro-galvanism trans- mitted through the liver, with good results; and the skin did not seem so dark in colour. His improvement, however, was but slight. An examination of the liver did not disclose any enlargement, nor were there any symptoms of gall-stones, nor, in fact, any positive indication of the precise seat of biliary obstruction. Early in December, whilst sitting up in the ward, he was suddenly seized with extreme dyspncea and hissing inspiration, and the symptoms were so urgent that tracheotomy was per- formed ; but death ensued within a few hours after the com- mencement of the attack, which a post-mortem examination revealed to have depended upon cedema of the glottis. The jaundice was at the same time found to have originated in ob- struction of the hepatic duct from extension of inflammation to the substance of the liver in its neighbourhood; and although the hepatic ducts were dilated, no bile was found in them. KING’S COLLEGE HOSPITAL. WARTY GROWTHS IN THE LARYNX, THREATENING SUFFO- CATION, IN A PREGNANT WOMAN ; TRACHEOTOMY ; DEATH IN FOURTEEN HOURS ; INEFFECTUAL LABOUR IN THE INTERVAL ; POST-MORTEM CÆSARIOTOMY. (Under the care of Dr. BUDD.) OF the many remarkable and rare cases which have appeared in the "Mirror" for many years past, but one only has pre- sented peculiarities in any way similar to the case recorded below. The instance to which we allude was that of a female admitted into St. George’s Hospital, under Mr. Pollock’s care, for syphilitic laryngitis. Tracheotomy was performed, labour afterwards set in, and she was delivered of a. living child whilst wearing the tube, and made a good reco- very, (THE LANCET, vol. ii., 1856, p. 48.) The patient whose case is here detailed (through the kindness of Dr. E. S. Thomp- son, house-physician to the hospital) was a woman at the full term of pregnancy, who had been subject to warty growths in the larynx for some months, but which were not detected during life. After being in the hospital for a few days, the dyspnoea was so urgent that tracheotomy was performed by Mr. Mason, the house-surgeon, with relief for the moment. The pains of labour set in, and every effort was made to effect a speedy delivery, but in vain, and she died fourteen hours after the windpipe had been opened. Csesariotomy was now resorted to by Dr. San- som, the physician-accouchenr’s assistant, and the child re- moved from its matrix, but all efforts at resuscitation were un- availing. Thus both mother and child were lost. The preg- nancy was a painful coincidence, as in Mr. Pollock’s case ; but its end was not so fortunate. We record the case in our series of laryngeal affections, as it happens to be one of a rare kind, depending upon growths from the mucous membrane of the in- terior of the larynx. Our space on the present occasion pre- vents our going more into the subject than to observe that it is possible that a diagnosis of their presence might have been made at a period when the symptoms were not so urgent, and when an operation would have held out better prospects of success. A florid-looking woman, thirty years of age, married, and nine months pregnant, was admitted into the above hospital, under the care of Dr. Budd, on the 10th of March, 1860. She stated that she had always been healthy, had had four chil- dren and two miscarriages, and had been subject to occasional sore-throat. She first observed an alteration in her voice in July, 1859; and on admission she could not speak above a whisper. Her breathing was attended with a loud stridulous noise. There was an occasional feeling of suffocation, but no difficulty in swallowing. She had a slight cough, with muco- purulent expectoration, which microscopical examination proved to contain lung tissue. Her face was dusky, lips blue, respira- tion hurried, and the breathing over both lungs feeble. There was some dulness at the apices, with harsh breathing and gurgling crepitus. There was no tenderness over the larynx externally. On introducing the finger into the fauces, the epiglottis felt somewhat thickened, and the vocal cords tumid and cushiony. A solution of nitrate of silver, half a drachm to an ounce of water, was freely applied to the vocal cords, and iodide of potassium prescribed, with some temporary relief. On the evening of the 16th of March, however, the breathing became much more difficult. Various antispasmodics and counter- irritants were tried, and local depletion, but without success; and towards morning the lividity of countenance and dyspncea became so great that a fatal termination was anticipated; she grew rapidly unconscious, and it was evident that she could not live many minutes. Tracheotomy was performed without difficulty by 3,lr.
Transcript of ST. BARTHOLOMEW'S HOSPITAL.
393
ureter, which in some positions exactly closed it, and had, no Idoubt, obstructed the flow of urine down it.Peter C-, aged twenty-five, admitted on Nov. 26th,
1859, under the care of Dr. Page. He worked at a baker’s.On the evening before admission he said he had gone to bedperfectly well; he awoke about one o’clock in the morningwith pain in his throat. At three he arose, as was his custom,and worked till six. At that time he was suffering greatlyfrom dyspncea. This continued until half-past nine, when hewas brought to the hospital. He was blue, struggling forbreath, and apparently at the point of death. Mr. Hammertonat once gave an emetic-dose of tartarized antimony, and bledhim to the extent of eighteen ounces. The emetic acted well,and the bleeding very greatly relieved him. He then had twograins of calomel every four hours. When he was seen atnoon, he way lying quietly, with a pale face, free from duski-ness, and with ruddy lips. The breathing was free from dis- tress-32 in the minute; the pulse 104, soft. He still com-
plained of pains about the larynx. The voice was low, butnot obviously unnatural in tone. The blood was neither cuppednor buffed. He was now seen by the physician, and laryn-gotomy was suggested; but, on consultation, it was consideredthat the case was not sufficiently urgent to warrant the ope-ration. He was visited in the evening by the physician, whofound him tranquil and easy, with no sign of venous blood inthe colour of the face or lips, a good pulse, and apparently ina promising state. He had a short time previously had a shortspasmodic attack of dyspnoea. About ten minutes after this,just after having expressed himself better, and got out of bedwithout help, he was suddenly seized with extreme shortnessof breath, turning blue, and struggling for air. The house-surgeon was in the hospital at the time, and the trachea wasopened as soon as possible, and before the pulse ceased; but henever breathed afterwards.Examination twenty hours after death.-The body was in
good condition. There was the mark of venesection on theright arm, and the blood being very fluid a large quantity hadrun out of the wound (which was quite recent) after death.The fauces and pharynx were quite healthy. There was verygreat oedema of the aryteno-epiglottidean folds, and of thewhole cellular tissue, as low down as the true vocal cords.The edges of the ventricle of the larynx were brought intoclose apposition by the swelling, and mucous fluid, of a milkyappearance, exuded from the sacculus on pressure. Below thetrue vocal cords there was no effusion whatever; but the mu.cous membrane was somewhat reddened. There was an in-cision into the upper part of the trachea, just above the rightlobe of the thyroid body, which would easily admit the passageof the index-finger. There were pleural adhesions of the rightside of the chest. All the viscera were healthy.
ST. BARTHOLOMEW’S HOSPITAL.
ŒDEMA OF THE GLOTTIS, SUDDENLY SUPERVENING IN
THE HOSPITAL, IN A CASE OF JAUNDICE FROMOBSTRUCTION IN THE HEPATIC DUCT.
(Under the care of Dr. FARRE.)IN addition to the two cases of dropsy of the glottis which we
noticed in St. George’s Hospital, the preparations of which wealso had the opportunity of examining in the museum, throughthe kindness of Mr. T. Holmes, the curator, another strikingexample came under our observation at St. Bartholomew’s, ofwhich the following is a very brief outline :-Thomas C-, aged forty, was admitted October 1st, 1859,
with icterus of five weeks’ standing. He had all the usual
symptoms consequent upon this: clay-coloured stools; sick-ness ; skin of a universal deep-yellow tinge, which extended tothe conjunetivse. He was submitted to mercurial and othertreatment with but partial benefit, after which ox-gall wasgiven with decided advantage for a time, and then discon-tinued. The mercurial treatment was abandoned on accountof the debility which it produced. On the 28th of Novemberhe was ordered gentle applications of electro-galvanism trans-mitted through the liver, with good results; and the skin didnot seem so dark in colour. His improvement, however, wasbut slight. An examination of the liver did not disclose anyenlargement, nor were there any symptoms of gall-stones, nor,in fact, any positive indication of the precise seat of biliaryobstruction.
Early in December, whilst sitting up in the ward, he was
suddenly seized with extreme dyspncea and hissing inspiration,and the symptoms were so urgent that tracheotomy was per-formed ; but death ensued within a few hours after the com-mencement of the attack, which a post-mortem examinationrevealed to have depended upon cedema of the glottis. Thejaundice was at the same time found to have originated in ob-struction of the hepatic duct from extension of inflammation tothe substance of the liver in its neighbourhood; and althoughthe hepatic ducts were dilated, no bile was found in them.
KING’S COLLEGE HOSPITAL.
WARTY GROWTHS IN THE LARYNX, THREATENING SUFFO-
CATION, IN A PREGNANT WOMAN ; TRACHEOTOMY ; DEATHIN FOURTEEN HOURS ; INEFFECTUAL LABOUR IN THEINTERVAL ; POST-MORTEM CÆSARIOTOMY.
.
(Under the care of Dr. BUDD.)OF the many remarkable and rare cases which have appeared
in the "Mirror" for many years past, but one only has pre-sented peculiarities in any way similar to the case recordedbelow. The instance to which we allude was that of a
female admitted into St. George’s Hospital, under Mr.Pollock’s care, for syphilitic laryngitis. Tracheotomy wasperformed, labour afterwards set in, and she was delivered of a.living child whilst wearing the tube, and made a good reco-very, (THE LANCET, vol. ii., 1856, p. 48.) The patient whosecase is here detailed (through the kindness of Dr. E. S. Thomp-son, house-physician to the hospital) was a woman at the full termof pregnancy, who had been subject to warty growths in thelarynx for some months, but which were not detected duringlife. After being in the hospital for a few days, the dyspnoea wasso urgent that tracheotomy was performed by Mr. Mason, thehouse-surgeon, with relief for the moment. The pains of labourset in, and every effort was made to effect a speedy delivery,but in vain, and she died fourteen hours after the windpipe hadbeen opened. Csesariotomy was now resorted to by Dr. San-som, the physician-accouchenr’s assistant, and the child re-moved from its matrix, but all efforts at resuscitation were un-availing. Thus both mother and child were lost. The preg-nancy was a painful coincidence, as in Mr. Pollock’s case ; butits end was not so fortunate. We record the case in our seriesof laryngeal affections, as it happens to be one of a rare kind,depending upon growths from the mucous membrane of the in-terior of the larynx. Our space on the present occasion pre-vents our going more into the subject than to observe that it ispossible that a diagnosis of their presence might have beenmade at a period when the symptoms were not so urgent, andwhen an operation would have held out better prospectsof success.A florid-looking woman, thirty years of age, married, and
nine months pregnant, was admitted into the above hospital,under the care of Dr. Budd, on the 10th of March, 1860. Shestated that she had always been healthy, had had four chil-dren and two miscarriages, and had been subject to occasionalsore-throat. She first observed an alteration in her voice inJuly, 1859; and on admission she could not speak above awhisper. Her breathing was attended with a loud stridulousnoise. There was an occasional feeling of suffocation, but nodifficulty in swallowing. She had a slight cough, with muco-purulent expectoration, which microscopical examination provedto contain lung tissue. Her face was dusky, lips blue, respira-tion hurried, and the breathing over both lungs feeble. Therewas some dulness at the apices, with harsh breathing andgurgling crepitus. There was no tenderness over the larynxexternally. On introducing the finger into the fauces, the
epiglottis felt somewhat thickened, and the vocal cords tumidand cushiony.A solution of nitrate of silver, half a drachm to an ounce of
water, was freely applied to the vocal cords, and iodide ofpotassium prescribed, with some temporary relief. On theevening of the 16th of March, however, the breathing becamemuch more difficult. Various antispasmodics and counter-irritants were tried, and local depletion, but without success;and towards morning the lividity of countenance and dyspnceabecame so great that a fatal termination was anticipated; shegrew rapidly unconscious, and it was evident that she couldnot live many minutes.Tracheotomy was performed without difficulty by 3,lr.
