both his nostrils were stopped for a moment, whilo water w as dashed on the face, when the patient, te clear the respiratory passage, hastily swallowed tha milk he had in the mouth. An electric shock from e galvanic battery often excites deglutitiou in the state of
insensibility.
Being fed with milk only, it brought on looseness afterwards, and the patient passed his stools and urine in his bed daily, which was a great nuisance to the rest of
APOPLECTIC TRANCE, OR PERFECT COMA OP
18
DAYS'
DURATION,
FOLLOWED
BY RECOVERY. By Assistant-Surgeon A. C. Kastaqir, North Suburban
Hospital.
One Jodunautli, aged about 22 years, was admitted into the North Suburban Hospital on 11th March 1879, perfectly unconscious, motionless, and insensible. His sister, who came with him, stated that he went on a spree with 3 others, became drunk, and quarrelled with them, for which he was severely beaten. Subsequently he was picked out by the police in a state of perfect insensibility, in which state he continued for 3 days, when he was brought to the hospital. On admission, the patient's right wrist was found very much swollen and red, and he bore an expression of painful sensation when the part was pressed ; the foreHis right eye, and arm was flexed on the upper arm. temple, were also much swollen and painful when pressed ; the right conjunctiva much congested and ecchywas perfectly insensible and motionless, mosed._ He breathing hard or snoring, with a faint stertorous sound in the throat ; the pupils of both eyes were very much dilated ; the pulse was small and somewhat frequent; respiration 25 in a minute, and skin cool. Patient has not taken any nutriment, nor even swallowed a drop of water during the last three days. Bowels are constipated ; makes urine in the bed. The hair being at once shaved, cold lotion was applied on his head, at the same time an enema of castor oil and-turpentine was given by the anus, which opened his bowels 3 times. He was fed by the mouth with milk daily in the folWhile lying down on his back his lips lowing way were drawn up, and kept apart forming a cavity, in which a mouthful of milk was poured; next I dashed a handful of cold water on his face and eyes, this was immediately followed by an act of deglutition and gasping respiration, and the milk got into the stomach at once. This process was repeated again and again till he had swallowed a pound or more of milk. In this way patient was fed 3 times a day. When this method did not succeed in exciting deglutition,
the patients. In this state of perfect helplessness patient continued for a fortnight in the hospital. On the 26th March, the patient first uttered a few indistinct words, with his eyes shut: was still not able to recognise his relations. Both his pupils continuing dilated, I thought it was a clear indication for the use of opium in small doses, and I ordered of a drop of laudanum to be given in water every 2nd hour. Next morning (28th March) the patient had opened his eyes, and recognised his sister, to whom he talked a few words. I discontinued the opium for a day, and, as I expected, the next day he was as insensible as before ; the opium in small and frequent doses was repeated, and he again became conscious, and remained so for the most part of the day. On the 5th April my assistant in my absence having applied some Belladonna ointment on his right eyelid (to relieve a pain on the part, of which the patient complained), within a few hours he became quite delirious, and continued so until the Belladonna ointment was thoroughly removed, and a good many doses of opium administered by the mouth. 1th April.?Patient though conscious now, is not able to sit up if lying down, nor to stand up when sitting ; walking of course is out of the question. His whole body trembles, as if all the voluntary muscles are quite powerless, or paralysed. The right upper lid still continues thick and swollen, for which he cannot Patient lift it ; the vision of that eye is impaired. being asked, says that he remembers being beaten when drunk, but knows nothing of what happened afterwards till the morning of 28th March, when he first recognized his sister. To remove the muscular debility I combined Liquor strychnine and laudanum in 4 minim doses, with 10 minims of Tincture of iron, with water, and gave it 3 times a day. 28th April.?The patient is now almost well; can walk with a stick, though his right eye sight is still weak. He is discharged at his own request.
Remarks. In this case the unconsciousness and insensibility were the combined effect of injury on the right temple and eye, and of drunkenness from the use of various intoxicating substance, of which spirit and country datura (Datura stramonium) appear to be the principal ingredients. 2. The method of feeding I adopted in this case, while the patient was perfectly insensible, deserves to be more extensively put to test. It saves the trouble of injecting nutritive fluid by the rectum 3 or 4 times a day, which is not only often inconvenient, but very objectionable, as in case of females of Besides the assimilative power of the rectum, natives. or colon, being very imperfect compared with that of the stomach, the quantity actually entering into the circulation is quite an insignificant part of what is thrown into the bowels, the rest being rejected and thrown out with the stools. This mode of feeding therefore can hardly sustain life for more than a few days. 3. In cases of opium-poisoning the antidotal virtue of Belladonna and its preparations is now commonly admitted ; so in case of poisoning by belladonna, opium is equally efficacious. In datura poisoning also, which is country belladonna, the physiological effects and uses 1.
Junk 2,
1879.]
THE LOCALIZATION OF CEREBRAL DISEASE.
of both on the system being identical, opium exerts the beneficial influence. Even in certain cerebral same affections with dilated pupils, if the use of one drug is more indicated than another, it is opium, which affects the pupil in an opposite way. The fact, that the patient regained his consciousness under the use of opium in small and frequent doses, when also the pupils became gradually contracted, proves without doubt that his unconsciousness was at least partly owing to his having takeu datura with the spirit he drank. 4. The rigidity of the right arm, the snore, and the slight stertor during respiration, and the prolonged coma, considered in connection with the injury of the right eye, and temple, all point to the conclusion that the brain was laboring under some pressure, or violent shake, and that 18 days' continued and prolonged insensibility was a pretty long period for a hopeful prognosis or for a favorable turn at the end, as in the present case.
3 67
insensibility.
Being fed with milk only, it brought on looseness afterwards, and the patient passed his stools and urine in his bed daily, which was a great nuisance to the rest of
APOPLECTIC TRANCE, OR PERFECT COMA OP
18
DAYS'
DURATION,
FOLLOWED
BY RECOVERY. By Assistant-Surgeon A. C. Kastaqir, North Suburban
Hospital.
One Jodunautli, aged about 22 years, was admitted into the North Suburban Hospital on 11th March 1879, perfectly unconscious, motionless, and insensible. His sister, who came with him, stated that he went on a spree with 3 others, became drunk, and quarrelled with them, for which he was severely beaten. Subsequently he was picked out by the police in a state of perfect insensibility, in which state he continued for 3 days, when he was brought to the hospital. On admission, the patient's right wrist was found very much swollen and red, and he bore an expression of painful sensation when the part was pressed ; the foreHis right eye, and arm was flexed on the upper arm. temple, were also much swollen and painful when pressed ; the right conjunctiva much congested and ecchywas perfectly insensible and motionless, mosed._ He breathing hard or snoring, with a faint stertorous sound in the throat ; the pupils of both eyes were very much dilated ; the pulse was small and somewhat frequent; respiration 25 in a minute, and skin cool. Patient has not taken any nutriment, nor even swallowed a drop of water during the last three days. Bowels are constipated ; makes urine in the bed. The hair being at once shaved, cold lotion was applied on his head, at the same time an enema of castor oil and-turpentine was given by the anus, which opened his bowels 3 times. He was fed by the mouth with milk daily in the folWhile lying down on his back his lips lowing way were drawn up, and kept apart forming a cavity, in which a mouthful of milk was poured; next I dashed a handful of cold water on his face and eyes, this was immediately followed by an act of deglutition and gasping respiration, and the milk got into the stomach at once. This process was repeated again and again till he had swallowed a pound or more of milk. In this way patient was fed 3 times a day. When this method did not succeed in exciting deglutition,
the patients. In this state of perfect helplessness patient continued for a fortnight in the hospital. On the 26th March, the patient first uttered a few indistinct words, with his eyes shut: was still not able to recognise his relations. Both his pupils continuing dilated, I thought it was a clear indication for the use of opium in small doses, and I ordered of a drop of laudanum to be given in water every 2nd hour. Next morning (28th March) the patient had opened his eyes, and recognised his sister, to whom he talked a few words. I discontinued the opium for a day, and, as I expected, the next day he was as insensible as before ; the opium in small and frequent doses was repeated, and he again became conscious, and remained so for the most part of the day. On the 5th April my assistant in my absence having applied some Belladonna ointment on his right eyelid (to relieve a pain on the part, of which the patient complained), within a few hours he became quite delirious, and continued so until the Belladonna ointment was thoroughly removed, and a good many doses of opium administered by the mouth. 1th April.?Patient though conscious now, is not able to sit up if lying down, nor to stand up when sitting ; walking of course is out of the question. His whole body trembles, as if all the voluntary muscles are quite powerless, or paralysed. The right upper lid still continues thick and swollen, for which he cannot Patient lift it ; the vision of that eye is impaired. being asked, says that he remembers being beaten when drunk, but knows nothing of what happened afterwards till the morning of 28th March, when he first recognized his sister. To remove the muscular debility I combined Liquor strychnine and laudanum in 4 minim doses, with 10 minims of Tincture of iron, with water, and gave it 3 times a day. 28th April.?The patient is now almost well; can walk with a stick, though his right eye sight is still weak. He is discharged at his own request.
Remarks. In this case the unconsciousness and insensibility were the combined effect of injury on the right temple and eye, and of drunkenness from the use of various intoxicating substance, of which spirit and country datura (Datura stramonium) appear to be the principal ingredients. 2. The method of feeding I adopted in this case, while the patient was perfectly insensible, deserves to be more extensively put to test. It saves the trouble of injecting nutritive fluid by the rectum 3 or 4 times a day, which is not only often inconvenient, but very objectionable, as in case of females of Besides the assimilative power of the rectum, natives. or colon, being very imperfect compared with that of the stomach, the quantity actually entering into the circulation is quite an insignificant part of what is thrown into the bowels, the rest being rejected and thrown out with the stools. This mode of feeding therefore can hardly sustain life for more than a few days. 3. In cases of opium-poisoning the antidotal virtue of Belladonna and its preparations is now commonly admitted ; so in case of poisoning by belladonna, opium is equally efficacious. In datura poisoning also, which is country belladonna, the physiological effects and uses 1.
Junk 2,
1879.]
THE LOCALIZATION OF CEREBRAL DISEASE.
of both on the system being identical, opium exerts the beneficial influence. Even in certain cerebral same affections with dilated pupils, if the use of one drug is more indicated than another, it is opium, which affects the pupil in an opposite way. The fact, that the patient regained his consciousness under the use of opium in small and frequent doses, when also the pupils became gradually contracted, proves without doubt that his unconsciousness was at least partly owing to his having takeu datura with the spirit he drank. 4. The rigidity of the right arm, the snore, and the slight stertor during respiration, and the prolonged coma, considered in connection with the injury of the right eye, and temple, all point to the conclusion that the brain was laboring under some pressure, or violent shake, and that 18 days' continued and prolonged insensibility was a pretty long period for a hopeful prognosis or for a favorable turn at the end, as in the present case.
3 67
