PERIODICALLY RECURRING COVULSIONS PRODUCED BY IMPACTED FECES.

BY J. F. BALDWIN, M. D., COLUMBUS, OHIO.

March 14, 1884, I was called, about 2 P. M., to see Mrs. G., a widow, aged sixty-seven, but apparently much older. I found her in convulsions, involving nearly all the muscles of the body. The eyes were turned up, the eyelids half open and twitching, the limbs jerking about, and there was a slight tendency to opisthotonus. On extending the arms at right angles to the body, they would remain rigid, as in catalepsy, except some fibrillary twitching, for some minutes, when they would gradually, and with increased twitching, sink to the side. She was entirely unconscious, and could not be aroused. She had been in this condition for three hours. Previous to this attack she had been about as well as usual, until within a day or two, when, not feeling quite so well as common, she had, on the day previous to my visit, taken a dose of salts, which had operated freely. She had a normal temperature and pulse. Had had no headache, nor any other symptom of any centric disease. ough examination failed to reveal any disease of the vital organs.

A most thor

I prescribed bromide of potassium in large doses, and in about two hours she became conscious, the convulsions ceased, and she said she felt as well as usual. She complained of no pain or uneasiness anywhere, and I was at an utter loss to account for the attack. An examination of her urine showed it to be normal. The bromide was ordered continued in diminished doses.

At II o'clock the next day the convulsions returned as before, and, notwithstanding the free use of the bromide, continued as long as on the previous day. This periodical recurrence of the attacks continued for four days, entirely unaffected by the varied sedatives and antispasmodics which were lavishly used. There being an entire absence of any indications of serious disease, and being impressed with the evident reflex character of the convulsions, I now, although her bowels had been reported as open daily, administered a full dose of croton-oil. This operated very freely, thirty or forty times, the nurse said, and on that day there was no return of the convulsions. But on the second day they returned as beShe was again plied with antispasmodics, but

fore, and at the same hour. without avail.

As the periodicity of the attacks was so marked a feature, I now administered quinine, thinking there might be a malarial element at the bottom of the trouble. This did no good.

Two weeks had now elapsed, with no perceptible change in the condition of the patient, except that she was weaker. I now recalled that I had treated her several years before for uterine procidentia. She þad, however, had no trouble from that source since I had furnished her with a supporter, and had for a long time discontinued the use of the instrument. Suspecting that there might be some irritation at that point, I made a vaginal examination. The uterus was in place, and in the condition of senile atrophy. But the rectum contained a mass of feces as large

as a child's head. The rest is soon told. The mass was broken down and removed in the usual way, and no more convulsions occurred.

The points of interest in the case are: There had been no history of constipation; the salts taken before I was called had operated freely; there was no constipation subsequent to the commencement of treatment; the croton-oil operated copiously and without scybala, yet the rectum was • impacted with a tough mass, resembling blue clay in consistence, without producing any symptoms pointing to the seat of the trouble.

I am at a loss to account for the periodicity of the attacks of convulsions, except as a part of that common tendency of disease and all functional activity.

TO CLEANSE THE GAIFFE BATTERY.-Dr. F. A. Burrall, of this city, writes: "I find that by putting salt and water into the cups of the Gaiffe battery, after they have been used, the yellow sulphate of binoxide of mercury is readily removed from them. This method is a good substitute or the vigorous brushing and scraping which are otherwise necessary. Those who use this convenient faradizer will, I think, appreciate the benefit of this information.”—N. Y. Med. Record.

PERMANENTLY MOIST COPYING PAPER may be made by moistening ordinary copying paper with a solution of one pound of chloride of magi nesium in one pound of water.

A CASE OF CESAREAN SECTION, WHERE THE PELVIS WAS NORMAL.

[Extracted from the Proceedings of the Cuyahoga County Medical Society, October 2, 1884, by L. B. Tuckerman, M. D.,

Corresponding Secretary.]

The case, reported by Dr. Arms, was as follows: The patient was a primipara, aged 22, weighing about 160 pounds. The waters broke three A. M. on Monday, June 3oth. Examination showed that the head was unengaged and the os undilated. There were no pains, except some slight ones when the waters broke. On the evening of Wednesday, July 2d, pains came on, recurring every six to eight minutes. The os was high up above the superior strait and was still undilated. Examinations at midnight, 4 A. M. and 9 A. M., showed no improvement. The left side of the abdomen was soft and compressible, while the right side was hard and the parietal suture could just be felt. The position was diagnosticated as R. O. P., or the 3d position. Pains were quite strong every four to five minutes. The os seemed soft and dilatable, but no progress was made and digital dilatation was undertaken and kept up for an hour and a half, when considerable dilatation was obtained. After waiting again an hour and a half, the dilatation was recommenced at I P. M. and in half an hour more it was sufficient to introduce the forceps. Chloroform was given and the first blade went on easily, but in applying the second some difficulty was experienced and the posterior lip of the os uteri tore a little. Forcible and continued traction was employed for nearly an hour without securing any real progress, for though the os dilated somewhat and the head came down far enough to allow the fontanelles, both anterior and posterior, and the greater part of both parietal bones to be felt, the moment the strong traction was removed it sprang back to its original position, high up, and seemingly forward of the axis of the pelvic brim. Version was attempted, but the womb grasped the fetus so closely that the hand could not be forced higher than the ear of the fetus. Craniotomy was performed, the cerebral contents evacuated and firm hold obtained by the cranioclast, and forcible traction again used without effect. Forceps were again tried, and Hodge's cephalotribe, but no hold could be obtained by either. At 6 P. M., Dr. Sawyer was called in council, who tried to deliver by means of the hook and cranioclast, but with no better result. The vagina was by this time hot, dry, and swollen, and the patient evidently sinking. Dr. Vance was then

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called, and the council decided upon Cesarean section. The patient was placed upon an operating table and Dr. Arms made an incision in the linea alba from the umbilicus to four inches above the pubes, which incision had to be subsequently extended upward. There was no bleeding or protrusion of the intestines. Hodge, Leischman and other authors allow two to two and a half inches above the pubes as the lowest limit of the incision, but if that rule had been adopted in this case the bladder would certainly have been cut into. It was just missed by allowing four inches. The placenta was beneath the cut and adherent. The incision was followed by appalling hemorrhage. The placenta was detached as quickly as possible and the fetus removed, when the hemorrhage at once ceased.

Three deep sutures were inserted into the womb. The abdomen was freed from blood-a much easier operation than in an ordinary laparotomy, owing to the disappearance of the pelvic cavity as the womb developsand the abdomen was closed by three deep sutures and intermediate smaller ones. Rubber adhesive plaster was placed over the wound; over that dry absorbent cotton, and finally a broad roller bandage. The operation was completed at midnight. The patient was bright the next morning, but the day following some pain set in, succeeded by vomiting, tympanites, and finally in about fifty-two hours after the operation by death. The autopsy showed a pelvis of normal size, and an edematous condition of the cellular tissue about the broad ligaments, extending down to the pelvic tissue.

[A point not reported to the Society, because not germane to the operation, may be of interest: There was a corpus luteum of pregnancy in the left ovary. The left fallopian tube was dilated into a cyst near its centre, the tube being occluded both toward the ovary and the uterus. The cyst, about the size of a walnut, had a villous lining and the muscular walls of the tube covering the cyst were much hypertrophied. This cyst opened into a larger one, in the broad ligament, about the size of a goose egg. The opening was small, with a cartilaginous rim, and the lining of the larger cyst smooth. It had every appearance of being an extra uterine fetation which had ruptured into the broad ligament.]

The child, minus brain and part of the skull, weighed 8 lbs. 1 oz. The left leg was found to have been so flexed upon the body as to bring the ankle in front of the left shoulder and the foot behind the left side of the neck and back of the occiput, and to cause its plantar surface to impinge with every pain upon the rim of the pelvis and prevent the

engagement of the head. The left. arm of the fetus was firmly clasped about the leg, effectually preventing its disengagement and in its own turn firmly held in place by the rigid walls of the contracted uterus.

Dr. ARMS further stated that he had been advised by friends not to report the case on account of the opposition it would be likely to arouse, but he felt that the case was a peculiar one, and though he had no authority in the books for his course, he had done what he deemed right and that he felt it his duty to report it.

Dr. THAYER thought the case had been badly managed. If the head did not engage when the os was dilated he should have turned, or if the womb had contracted snugly about the fetus after having introduced instruments and failing with them, he should have eviscerated. Dr. Delamater had in his presence eviscerated in a case of arm presentation— where the woman had sat down on the arm and broken it. Any one would know that it would be death to the patient to perform Cesarean section under such circumstances.

Dr. ALLEN inquired the relative safety of Cesarean section and the Porro operation. He called attention also to the superior hold that the occiput or the face gave to the cephalotribe as compared with other portions of the cranium.

Dr. VANCE stated that Cesarean section gave 42 per cent. of recoveries while Porro's operation gave 30 per cent. These were the last statistics

he had seen.

Dr. HERRICK did not approve of the capital operation, though he had no doubt of the honesty of the gentlemen who performed it. It seemed to him as though decapitation could have been performed, and he was inclined to believe version could have been performed. He disapproved of the practice of digital dilatation of the os uteri.

Dr. ARMS inquired how you could decapitate when the head was the presenting part and when the finger could not be carried above the ear; and, besides, the vulva was very much swollen and the mucous membrane quite dry.

Dr. CUSHING said that his sympathy was with the man who had to shoulder the responsibility. Any case of first labor was an anxious one if the waters had drained off before the os became dilated. We must interfere, we must open it, for it would never open of itself in a case of this kind. We must dilate, and it is a matter of judgment whether you do it with the fingers or with Barnes' dilators, which latter, besides being liable to burst, are not easy to use in a primiparous vagina with an undi