Eleven o'clock P. M. Complains of restlessness, and appears very despondent. From the dormant state of the liver, it was agreed to endeavour to assist the operation of the calomel by a brisk cathartic, and gamboge was thought most likely to remain on his stomach; four grains of which were accordingly given, and retained, but without the desired effect. Three o'clock. Gave him three grains of calomel, and an enema of Pulv. Ipecac. 3ii.; Magnes. Vitriolat. 3i.; Congee water 3xv., which was ejected, after being retained for a few minutes. Five o'clock. Countenance expressive of great mental agony; conceives himself beyond all hopes of recovery. Six o'clock, no alteration in his evacuations; skin still moist, and the stomach retains all the medicines. Blister rose well; pulse very feeble. Pulv. Jalap. gr. -xxv. to be taken in a little jelly. Ten o'clock. Remains the same; no alteration in his evacuations; agree, if possible, to effect a change by mercurial frictions, combined with camphor, on his thighs and arms, every two hours; and one grain and a half of calomel to be taken every hour, in a little jelly; which was continued, until his decease. Eleven o'clock A. M. The pulse began to sink, extremities clammy; hot bricks, warm applications, and frictions, applied; and he was supported with small quantities of brandy and water. From twelve until two, he took warm congee and tea, and slept a little; appears rather better. He continued in the same state until nine o'clock, during which period he was supported with soup and hot brandy and water; half-past nine he started from his bed, had a convulsive spasm, and instantly expired. Dissection. I examined the body in the presence of Mr. Surgeon Davies. The liver appeared sound, but of a paler colour than usual, the gall-bladder was much distended with bile, of the consistence and colour of tar; the spleen aud pancreas quite healthy; the stomach empty, and of a natural appearance; the intestines, particularly the duodenum throughout their internal structure, were lined with bilious matter, nearly of the same colour and consistence as that of the gall-bladder, which adhered firmly to their villous coats; no appearance of fecal matter in any part of the caual; the urinary organs sound, and the bladder empty; no appearance of inflammation in any of the viscera of the abdomen. On examination of the thorax, the heart and pericardium were found in a sound state; the lungs were completely distended with blood of the darkest colour; the left lobe, to all appearance, must have ceased performing its functions some hours previous to death; the right was nearly in the same state, except a small portion, which appeared nearly in a natural condition. On examination of the head, there was not any appearance of a determination of blood to that organ; and, after a careful dissection of the brain, there did not appear any fluid in the ventricles, or any other appearance of disease. CASE XI. John Burnes, private, October 28th, complains, eight P. M., of vomiting and purging, attended with severe spasms of the lower extremities; great prostration of strength; skin cold; pulse small and rapid; eyes dull and heavy; uneasiness of the epigastric region; says he was attacked with the above symptoms in barracks a few hours after his return from Madras. He is ordered immediately of laudanum 120 drops, tincture of capsicums, two drachms; spirits, three ounces; fomentations to the abdomen, heated sand and bottles with warm water, to the extremities; spirits and water, and ginger tea, for drink. The spasms abated considerably for nearly an hour, and the vomiting and purging ceased for the same time, when, at ten A. M., the spasms and other symptoms returned with increased severity; the former extending to the thorax and upper extremities, affecting his breathing and hearing, and he appeared to • Garrison-Surgeon M'CABE, Poonamalee, October 1818. labour under excessive sufferings. The abstraction of twenty-five ounces of blood from the arm was productive of immediate and permanent relief from the spasms, and other painful symptoms. He is now ordered the following draught, and, after it, twenty grains of calomel, and to be repeated as occasion may require. Tinct. Opii gtts. 130; Tinct. Capsic. 3i.; Spts. Ether. Vit. 3i.; Spt. Tin. Ziij. ft. h. Fomentations, &c. to be continued. 29th. He had a tolerably quiet night, and it was not found necessary to repeat the draught. At nine A.M. he vomited some yellow bilious matter, and had a small stool of the same appearance.-He is ordered twenty grains of calomel instantly, with Aq. Menth. 3j.; Tinct. Opii, Spt. Æth. Vit. äā gtt. xl. Two P.M. Stomach settled; complains of giddiness and thirst; no motion; urine free.Inf. Sennæ comp. 3iv.; Tiuct. Cardam. ziv.; Tinct. Jalapæ ziij. statim sumendus. Six P.M. Three copious motions. Says he feels his body all over sore, and a stiffness in his legs and hands. He is ordered the following: Calomel, Camphor, ää gr. iv. h. s.; Mist. Camph., Aquæ Menth. ãã 3jss.; Tinct. Opii, Spt. Æther. Vit. ãã 3i. fiat h. s. s. 30th. He had a good night; complains only of a soreness of his breast and limbs. Cases of the Mixed Form of Cholera. Darwar; 12th July, 1826. CASE XII. Lieutenant S. had for some time been labouring under a derangement of his stomach and bowels, having occasionally slight nausea and diarrhea. This complaint had been removed, and he was sufficiently well to attend to his various duties. When out in the middle of the day, in his palankeen, he became rather suddenly sick, and vomited what he had eaten at breakfast, and also a little bile. He considered this to be merely a return of his stomach complaint, and at the house of a friend he took forty drops of laudanum, which checked the vomiting. When he returned home, the vomiting recommenced with violence, and was accompanied with purging; he sent for me immediately. Before I arrived he had vomited very often, and had been purged above twelve times. At first he vomited a large quantity of bile, but when I saw him he was vomiting transparent and nearly colourless serum; his stools were copious, watery, at first bilious, afterwards nearly colourless. When I first saw him, at one P.M., he complained of a sinking at his stomach, pain in his abdomen on pressure, thirst, and parched mouth, and two or three times of spasms in the muscles of his neck and calves of his legs; his features were considerably collapsed, pulse at the wrist thready, skin warm. Sixty drops of laudanum were given to him in a little warm water; two veins were opened in his arm, and, with considerable difficulty, about fourteen ounces of rather dark-coloured blood were obtained; a large blister was applied to his abdomen, and cataplasms of mustard and capsicums to his feet. The laudanum was retained about a quarter of an hour, when vomiting recommenced. A scruple of calomel was then given, and was washed down with one drachm of æther, thirty drops of laudanum, and some warm water; warm barley-water was given to him occasionally. After the bleeding, his pulse improved a little; he retained the medicines and barley-water; and by four o'clock there was a great improvement, the vomiting and purging having ceased, and the spasms having been entirely removed. He took no more medicine, and I left him with directions that he should only have some barley-water, with a little white wine. I saw him again at seven o'clock, when he told me he had perspired a good deal, and now felt perfectly easy. He had a feculent evacuation next morning; his mouth became slightly affected by the calomel, and he speedily recovered. Observations. In this case the bilious vomiting, pain in the abdomen, thirst, parched tongue, and spasms, clearly shew that there was inflammation of the gastro-enteric mucous membrane. The collapsed features, small pulse, great discharges of serum by vomiting and stool, prove that the action of the secretory vessels of the gastro-enteric mucous membrane was increased. The indications of cure were evidently, first, to repress the vomiting, in order to enable the other medicines to remain on the stomach; secondly, to diminish the increased and to support the healthy action of the gastro-enteric mucous membrane; I thirdly, to restore the circulation towards the surface. The first was effected by means of the laudanum and æther; the second, by means of the bleeding, calomel, and laudanum, assisted by all the other remedies; the third, by means of the blister and sinapisms, by the general stimulating property of the calomel, and evidently also by the venesection. An abstract of ninety-four cases of the disease is given by Mr. Mouat, in his Memoir on Cholera, in the third volume of the Transactions of the Physical Society of Calcutta; but as many of them belong to the low form of the disease, and as we have only to do with the mixed form at present, I will select some cases of the latter as examples, and in the author's own words. John Casey 17th, Seized with pain Bled to twenty Convalescent. 10 P.M. 11 P.M. in epigastrium; vo-ounces; calomel in miting, but no scruple doses; blispurging; pulse ter to epigastrium; quick; skin hot; magnesia for the occasion-vomiting; friction: cramps ally. small afterwards Henry 17th, tives. Vomiting and purg-Bled to thirty oz. ;Discharged Cavanaugh 5 A.M 8 A.M. ing; pulse feeble; scruple doses of ca- well. Christopher 17th, skin hot; counte-lomel; afterwards nance a little alter-purgatives. ed, and great thirst. Bilious vomiting; Bled to twenty oz.; Discharged Travesick 4 P.M. 5 P.M. frequent watery scruple doses of ca stools; anxious, lomel, with lauda- afterwards at the epigastrium; calomel, antimony, fast. well. James 20th 2 P.M. Vomiting of watery Scruple doses of ca-Discharged Watts bilious fluid; purg-lomel; blister to the well. ing; pain at præ-scrobiculus cordis; ous and faint, sink-afterwards purga- John Shell 27th, Seized with severe Small doses of calo-Doing well. 8 P.M. 10 P.M. Vomiting of bilious mel, with opium; matter, succeeded frictions; anodyne by watery stools; enemas; stimulatoppressed, very ing draughts; blislow, aud dejected; ter to the epigaspulse feeble; severe trium; brandy, and cramps in legs and sago. thighs; cold sweats, skin clammy; pain and heaviness at the epigastrium. Seized with vomit- Blister to the scro-Convalescent. John Rickett 28th, 8 A.M 9 A.M.ing, succeeded by biculus Matthew 28th, cordus; bilious purging; large doses of ca- legs; griping pain anodyne enemas. trium; eyes red and heavy; skin cold and lamp; great thirst; pulse feeble. Purging; vomiting Bled twice; scru- Convalescent. 6 P.M. 8 P.M. of bilious matter; ple doses of calopain at the stomach mel, with opium. pulse quick; great restlessness. Richard 10 A.M. 11 A.M. Seized with pain in Bled to twenty oz.; Kemp CASE I. belly, succeeded by scruple doses of ca- fomenta ing of watery fluid; tions; magnesia for legs. Cases of Inflammatory Cholera. Convalescent. Nellore; 16th May, 1823. Burns, gunner, æt. thirty-five, is a sober man, and has enjoyed very good health since he left St. Thomas's Mount. Four P.M. Was exposed a good deal to the sun to-day. About two hours ago he was attacked with vomiting and purging of a green bilious matter. Complains of severe pain and burning at the epigastrium, spasmodic pains in his bowels, and intense thirst; severe spasms occur, at short intervals, in the calves of his legs; pulse 100, full, and hard; tongue furred, dry; skin warm; countenance anxious.-Emittantur sanguinise brachio 3xxiv. R. Calomeli.; Opii gr. i. Misce, fiat bolus statim sumend. R. Tinct. Opii 3ss.; Ol. Olivar. Zi. Misce fiat embrocatio qua perfricetur abdomen. 17th, mane. Was much relieved by bleeding; no vomiting or purging since last report; the pain and burning at the epigastrium, and the spasms, gradually ceased. Had a small green-coloured stool this morning, and complains of pain in his bowels; pulse natural; tongne furred.— Sumat statim Sulphatis Magues. 3i. The salts operated freely, and he got completely rid of the complaint: it was succeeded, however, by a diarrhoea, which soon yielded to opium and ipecacuanha. CASE II. Coduganoor; 17th May, 1823. - Harris, gunner, æt. forty. Half-past two P.M. Exposed himself a good deal to the sun this forenoon. Was attacked, about half an hour ago, with purging, which he says was at first feculent, afterwards watery, bilious, and slimy; complains of severe pain and burning at the epigastrium, spasmodic pain in his bowels, intense thirst, and nausea; no vomiting; violent spasms occur occasionally in his extremities, and sometimes in his back; pulse 100, full, and hard; countenance anxious, and expressive of great pain; tongue furred, dry; skin hot and dry.-Emitt. sanguinise brachio 3xxxvi. R. Calomel Əi.; Opii gr. i. Misce, fiat bolus statim sumend. R. Tinct. Opii 3ss.; O1. Oliva. 3i. Misce, fiat embrocatio qua perfricetur abdomen. Six P.M. He was almost immediately relieved by the bleeding; complains now only of weakness and thirst; is perspiring.-Habeat aquam oryzæ tepidam pro potu. On the 18th he had slight dysenteric symptoms, which however were easily removed, and he soon recovered. COLLECTANEA. Floriferis ut apes in saltibus omnia libant, PHYSIOLOGY. Memoir on the Functions of the Encephalon, including a brief Notice of most of the recent Doctrines. M. ROLANDO considers that his experiments have proved that the medulla oblongata is the centre of sensibility, the focus and source of life. Treviranus regards it as the centre of animal life, at least. Fodera deems it to be the "hypomoclion" or under lever of life. It is, according to him, the main exciter of respiration, circulation, digestion, and of voluntary motion; the influence which it exerts, proceeding in an especial degree from the point whence the pneumogastric nerves arise; this point is the line of demarcation between the medulla oblongata and spinalis. The portion of the medulla situated below this point serves only to transmit impressions received; and the portion of the medulla oblongata situated above this point, is not the source of any influence, nor the centre of any action. The brain and cerebellum are only appendages to the medulla oblongata; and all irregularities of the sentient and moving powers which are observed in diseased states of the mass of the encephalon are referrible to sympathetic derangements in the functions of the medulla oblongata; for this latter part is invariably the only real and true seat of palsy. According to M. Serres, the whole encephalon is endowed with sensibility, but the medulla oblongata is the principal seat of it. M. Flourens places the source or centre of vitality, and of the nervous power, in the medulla oblongata. |