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thoscope, Dr. Jackson agreed with of April,) the body was me in the belief that the sound of mined. External appearance respiration could be heard at the natural as to color; the whole upper part of the chest, and thinks body much emaciated ; abdomen it now probable that, at that time, very large and hard, and particu(viz. a fortnight before death,) larly protuberant on the left side. the upper part of the right lung The tumor on the right side very might have admitted air. It ap- distinct, pressing out the three peared to me that the sound of lower ribs, though without any respiration could be indistinctly appearance of pointing. heard at the very lowest point of making an incision down over the the tumor, which led me to think sternum and linea alba, the inteit probable that the abscess might guments and muscles were found be below the diaphragm. Dr. J. exceedingly thin. On opening inhowever, concluded that the right to the abdomen, the liver appearthorax was the seat of the disease, ed to occupy almost the whole of though it could not be determined it ; being forced out of its place whether the pus was formed in by pressure above the diaphragm, the substance of the lung, or be- which was observed to be protween the pleuras. He advised truded downwards quite into the to watch carefully for any ap- abdomen. The ribs of the right pearance of pointing externally, side were forced apart by the and if it should happen, that the distention from within, so that the abscess should be opened. muscular covering of the chest
The tumor extended so low was very thin, and accidentally, that it was evident the diaphragm while removing the integuments, was much pressed downwards, if it was touched by the knife, and indeed the tumor were not below immediately there followed a jet it. From this time, the little of purulent matter to the height patient began more evidently to of nearly a foot. The opening
his breathing became every was immediately enlarged, and day more and more laborious, and the body turned over, that the he was obliged to choose the se- remainder might be caught in a mi-erect position, inclining to the vessel ; and as nearly as we could right side ; until, for some days determine, about two quarts of a before his death, every power of thin greenish pus, filled with flohis system, both mental and cor- culi of coagulable lymph,were disporeal, was brought into requisi- charged. Upon minute examination to assist in respiration, so that tion, it was concluded that the for several days and nights he lungs were sound on both sides, could scarcely lose himself for a that the abscess was formed bemoment in sleep, without danger tween the pleuras, and that the of suffocation. He finally died, right lobe of the lungs was so enapparently from the continued and tirely compressed by it as to be increased pressure upon the bron- completely useless. The mediaschiæ, rendering it impossible for tinum was pressed considerably him to draw another breath. He towards the left side. The left retained his senses to the very last. lobe of the lungs appeared small,
Twenty hours after death, but healthy. (which took place on the 15th Boston, Ipril, 1828.
Additional Case. By John WARE, disappeared, and the remaining M. D.
part of the cavity of the chest had In connexion with the preceding had escaped.
been occupied by the gas which
On a more particase, it will perhaps be interest- cular examination, the remains of ing to relate one having some the lungs were found at the upper points of resemblance with it, par part of the cavity, without any ticularly as it respects the ap- breach of surface whatever, or pearances on dissection.
actual loss of substance by ulcerWilliam Parsons, aged 25, was ation, but compressed by the effuadmitted into the Boston Alms- sion of fluid and gas into the cavity House July 16th, 1824, in a state of the pleura, to a size not larger of great distress. He had re- than that of a man's fist. The ceived an injury upon the right form, relative size, &c. of the side of the chest some time since, several lobes were perfectly diswhich had been followed by his tinct, although they had shrunk present complaint. His symptoms away into the appearance of little were those of an advanced stage shrivelled knobs, and looked very of unrelieved pneumonitis or pleu- nearly as they would have done risy. The pain in the side was after soaking for a long time in a most excruciating; the respira- strong alcoholic solution of corrotion was short, laborious, hurried, sive sublimate. The pleura linwas carried on with great agony, ing the chest had been highly inand could not be maintained in the flamed, and was covered by a layhorizontal posture without much er of' dark colored coagulable distress. The pulse were very lymph. quick. The cheeks, lips and tongue livid; the extremities livid
II. and cold. The stethoscope was not applied, but upon percussion A Case of Malignant Chickenpox. the left side of the chest gave the natural sound, whilst the right re
By D. HUMPHREYS STORER, M.D. sounded as if it were hollow. On the 29th of April, between 8 This patient was bled, blistered, and 9 o'clock, A. M., I was called and treated by mercurials. He to visit a child of Mr. James was relieved in some measure of Spear, in Front Street. The child, his distress, and was able in some a boy eight months old, was found degree to lie down; but died Ju- lying in its mother's arms, in a ly 19th.
Before an opOn dissection, when the skin portunity was afforded me of had been removed and the carti- making any inquiries, the mother lages of the ribs cut through, very anxiously desired my opinion there was a great escape from of the disease. Several vibices the right side of a very fetid gas. situated on the forehead and left When the sternum was removed, temple, four or five in number, the right cavily of the thorax one or two of the size of a fourseemed to be half full of a dirty, pence, and varying in color from whey-like sort of pus, with shreds a light brown to the darkest veof lymph floating in it. The lungs nous blood, first claimed my atseemned at first to have entirely tention. It being impossible to
distinguish the nature of the ori. day of the 28th, no peculiar apginal eruption from these appear- pearances were noticed; no inances, the mother was requested creased febrile affection was obto undress the child. Upon ex. served ; the breast was taken amination, the body presented readily, and the excretions were great marks of exhaustion. The natural. On the evening of the glutei were found covered over 28th, the vesicles on the forehead their entire surface with petechiæ, and abdomen began to change to a most of them quite small, of a deeper red; and with this change dark purple color. Upon each in the appearance of the eruption, hypogastrium several vibices were increased heat on the surface of observed, three or four of the the body, refusal of the breast, size of a half cent, surrounded and incessant restlessness, were with a bright red areola, -in one remarked. These symptoms conor two instances nearly an inch in tinued until six in the morning, diameter, and in hardness and ex- when the child appeared better, ternal appearance resembling the became more quiet, and nursed inflamed surface around the vac- with some avidity. Between six cine vesicle. Surface of extre- and eight, however, the anxiety of mities presented no unusual ap- the parents was increased by a repearance : breast and back of turn of heat and restlessness. Durshoulders covered with well-mark- ing the night several evacuations ed vesicles of chickenpox. The of a natural appearance had ocextremities were cold: the tem- curred from the bowels : no urine perature of the trunk of the body was passed during the night, but was considerably diminished. The between six and eight in the mornradial arteries were scarcely per. ing, the bladder was two or three ceptible to the touch. Some nau- times evacuated; urine presented sea was present, and slight hic- no peculiarity. cough. Upon being told the child I determined immediately to was affected with chickenpox, the endeavor to bring about a reacmother's anxiety was somewhat di- tion by emetics; and accordingly minished, and from her I was epa. wrote for an antimonial. As, bled to collect the following his. however, during the few moments tory of the case.
necessarily occupied by the exaTwo of her children had just mination, my patient evidently recovered from this affection, became more comatose, and the which was quite prevalent in the probability of relief less, I felt neighborhood at the time. Both desirous for a consultation. Dr. of these children suffered but George Hayward was called. slightly--no more than children The case was considered by him generally, with this disease. Symp- an uncommon one ; he expressed toms of disease first showed them- his opinion decidedly, that unless selves in my patient on the morn- the system could be aroused withing of the 27th, when the vesicles in a short time, my patient must appeared in every respect similar sink. He advised the wine of to those of the other children, ipecacuanha in conjunction with with the exception of a greater the warın bath. I remained with degree of redness. During the the child till between one and day and night of the 27th, and the two o'clock. The exhibition of
three ounces of the wine of ipe- duced by emetic substances, which cacuanha, and four grains of tar- had passed through the stomach, tarized antimony in divided doses, and lodged there. The kidneys, with every effort to procure vo- in situ, presented somewhat of a miting by irritating the fauces, singular appearance, being rather applying pressure to the epigastri- larger than usual, and very black, um, and making frequent changes looking like clots of blood. Being in the position of the body, pro- removed from the body and their duced no effect. The bowels gubstance cut into, the parietes were freely opened during the of the pelvis were found consiforenoon ; evacuations therefrom, derably hardened ; cavities of the natural. Finding it impossible to pelvis empty; ureters and bladexcite the system by emetics, as der were seen perfectly healthy; a dernier resort cordials were or- Upon removing the scalp from dered freely, and sinapisms were the cranium, its inner surface was applied to the extremities. My found considerably injected, those patient gradually sunk, and ex- parts particularly, over the pariepired at 10, P. M.
tal bones. Between the integuNo alteration for the worse was ments and cranium some water observed in the petechiæ, or vibi- was effused : water was also efces, after 11 o'clock, A.M. I say, fused under the arachnoid memfor the worse ; a slight change did brane. There was a slight detake place after the first applica- gree of congestion in the vessels tion of the warm bath, which on the surface of the brain. The gave us some hope : the purplish ventricles contained no unusual tinge seemed to change to a light- quantity of fluid. The substance er shade, as if vitality had not en- of the brain showed no marks of tirely ceased there. This altera- disease. tion, however, was observed but
Remarks. for a few moments ; the parts soon It is worthy of remark, that the presented their former morbid patient in whom this affection characters.
made its appearance, was a reThe body was examined twelve markably healthy, fine looking hours after death, in presence of child, -the most robust of the my friends Drs. Robinson and family. John Flint. No appearance of I am acquainted with no author derangement could be seen in the who speaks of a similar terminalungs or heart. The abdomen tion of this disease. Heberden being opened, the liver was found refers to an eruption which he healthy, gall-bladder full of bile, conceives may be a “ malignant spleen presented nothing peculiar. sort of chickenpox;" but which The stomach was considerably differs from the case above dedistended with flatus, containing scribed, in the severity of the no liquid whatever ; its villous febrile affection preceding the discoat at the pylorus redder than at ease, in the length of the disease any other part, but not unusually itself, and in the vitality of the
The vessels of the mucous system not being exhausted ; in a membrane of the duodenum, to word, which resembles this case the extent of three or four inches, only in being an aggravated form were considerably injected, pro- of this affection. bably owing to the irritation pro Boston, May, 1828.
vent the motion of the joints, and From the London Med. Repository.
keep the limb quiet.
Mr. James Rolfe, the father of MALA PRAXIS.
the plaintiff, said he was not preRolfe vs. STANLEY.
sent when Mr. Stanley examined A CASE of great interest to me- the plaintiff's knee, but when he dical men was tried in the Court came down stairs he prepared of Common Pleas about a fort. him for the worst. He said the night ago. It was an action brought plaintiff would have a stiff joint as by a person named Rolfe against long as he lived, and that he might Mr. Stanley, Assistant Surgeon be glad if nothing worse occurred. to St. Bartholomew's Hospital, to He added, that there was a shockrecover damages for an alleged ing fracture, and about the fourth neglect and want of surgical skill or fifth part of the knee-pan was in the treatment of an injury of broken off. The splints remained the knee-joint. We shall lay be-on for five or six days, when Mr. fore our readers the evidence Stanley took them off and bent given on the occasion, as well as the knee, which caused such .exthe charge of the learned judge to cruciating pain, that the plaintiff the jury, and leave them to form was obliged to request him to detheir own opinion of the merits of sist. When the splints pressed the case.
on the hard substance, it made Mr. Sergeant Cross stated the him quite sick with pain, and he case, and called the following wit. was always pushing them down. nesses:
When this was told to the deMr. Henry V. Garman stated fendant, he said the patient must that he is a surgeon-apothecary. have patience. Mr. Stanley used On the 2d of December, 1826, sometimes to attend twice a-day he was in the neighborhood of for the first six days, and when Mile-end road, and was called to spoken to on the subject, he said attend the plaintiff. He found the knee-pan was broken, and the him in a cottage about half an hard substance felt in that part hour after the accident occurred. was a portion of the knee-pan, He appeared to have received a broken off. On the 18th of Janulaceration of the right knee-pan, ary, he said he could not do any in which there was a hard and more for him, and that his cure movable substance. He washed depended more on himself than away all the superficial particles, upon him, the defendant. When and, after putting on some simple the plaintiff got well enough to be application, he took him bome. removed, he was sent to HamHe went first for Mr. Green, the mersmith for a change of air. surgeon, but not finding him at The wound then swelled as large home, called for Mr. Stanley, as his head, and discharged a who resides in Lincoln's Inn fields. quantity of matter, in consequence He came in three hours after, of which it was necessary to call and the patient's knee was more in Mr. Lilly. The plaintiff was swollen. Mr. Stanley appeared not able to attend to business durto me to have made a proper ex- ing this time. amination, and he requested me Cross-examined-He did not to put the limb in splints, to pre- walk to see the Duke of York's