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Hospital Reports. Queen's Hospital, Birmingham. Cases Admitted under Dr. David NelsonAuthor(s): ObservatorSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 16, No. 1 (Jan. 7, 1852), pp.10-12Published by: BMJStable URL: http://www.jstor.org/stable/25493235 .

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10 QUEEN'S HOSPITAL, BIRMINGHAM.

3.?Added the ammonio-sulphuret of copper, which

produced a greenish blue precipitate; not the usual pale j

green?Scheele's. 4.?Added the ammonio-nitrate of silver, which pro

duced a reddish brown, or chocolate; not the usual colour I

?canary yellow, which appears with arsenious acid. The

result surprised me, because it proved the presence of

arsenic acid, not arsenious or common white arsenic of

the shops; repeated the experiments several times, but

always with the same results.

5.?I then poured some of the tea which had been

previously prepared, into a porcelain dish, added a

proper quantity of hydrochloric acid, brought it to near

the boiling point, put in some thin bright copper, which

immediately caused a deposit of arsenic upon it.

6.?I then introduced the sulphuret of arsenic into a

glass tube, with black flux, decomposed and sublimed

it, which proved to a demonstration the presence of

arsenic.

But the question for my consideration was,?How could arsenic acid, an article never kept in retail shops, and confined exclusively to the chemist's laboratory, have got into the tea pot ? This I was surprised at, and

for some time puzzled with, until I began to reflect that

carbonate of soda had been put into the teapot along with

the tea, and that arsenious acid was capable of uniting with it, and forming a neutral salt, the arseniate of soda, which is easily soluble in water, and this would account

for its slight action on litmus paper. The brown pre

cipitate of arseniate of silver by ammonio-nitrate of

silver, and the greenish blue precipitate of arseniate of

copper, in neutral solutions of arseniates, are both

very characteristic tests.

Lastly.?Measured two ounces of the prepared tea, added sulphuretted hydrogen, filtered, dried, and

weighed the precipitate; weighed eight grains, or about

equal to six grains of white arsenic of the shops. The

patient, therefore, must have taken in the eight or ten

ounces of tea, about half a dram of arsenic.

Thomas Cocker. Ashborne.

QUEEN'S HOSPITAL, BIRMINGHAM.

CASES ADMITTED UNDER DR. DAVID NELSON

Reported under the terms proposed by the Association,

By Observatoe.

Case of Hemiplegia,

From the frequent occurrence of paralytic cases, and

the very frequent incurability of such cases, it is probable that by some persons (particularly those who have

witnessed many really or assuredly incurable <tases) a

too general opinion has been formed, namely, that

nearly all are hopeless, or, at best, only admit of slight

palliation. Instances of recovery are sometimes re

corded, and to add one, of at least comparative recovery to that number, in the hope that it may contribute

some degree of encouragement to treat patiently and

perseveringly this truly pitiable class of suffering fellow-mortals, affords me much pleasure in reporting the following case :?

John Barrett, aged 35, of phlegmatic temperament, was admitted an in-patient of the Queen's Hospital, under Dr. Nelson, on the 20th of December, 1850.

He was completely insensible when admitted, but,

according to the statement of his friends, after taking

supper on the 17th, he went to bed in seemingly good

health, not making any complaint; on the following^

morning he was called, and made a correct reply, but

on getting up he fell down, and became insensible,

j remaining so until about the 21st.

i Symptoms.?Loss of sensibility and motion ; pale

j ness of countenance; pupils contracted and sluggish;

slightly increased heat of the head; the mouth was

drawn to the left side, and the muscles of the right

; side unnaturally soft; the right arm and leg were more

especially incapable of any movement, but a slight

degree of sensation existed, as a slight expression of

countenance indicated when he was pinched; the bowels

were constipated, but the urine passed involuntarily;,

pulse slow and full, 65 to 70.

Diagnosis.?Apoplexy, with hemiplegia. indications.?To prevent effusion and inflammation,

and to promote^absorption. Treatment.?The head was shaved, and cold applied

constantly; six leeches were applied behind the ears,,

followed by blisters; a pill of calomel and croton oil,, followed by a draught of sulphate of magnesia, jalap, and senna, was administered every second hour.

21st.?He seemed somewhat better. He took two

grains of calomel every second hour, and continued

the draughts. Also a seton was inserted.

22nd.?Improving a little, now having intelligence

enough to open his mouth, but could not protrude his

tongue, which, with his teeth, was coated with a black

fur. The right arm and leg were utterly powerless. Continued the medicines, with a draught of ammonia

occasionally. 23rd.?He still gradually improved, and had taken

food several times. The skin was a little more sen

sible. Continued the medicines.

24th.?The bowels had been freely opened, but no

mercurial effects had been produced. The pupils were

natural. The tongue, which he drew out with his left

hand, when asked to show it, was brown and dry. The

hemiplegia continued, and he answered " yes" to every

question. Pulse 80, softer.. Continued the medicines.

| 27th.?The tongue was clean, but the other symptoms remained the same. Continued the medicines.

I 31st.?Seemed about the same. He continued the

| mercury, with an aperient draught occasionally.

January 3, 1851.?The head was cool, and the tongue clean. He had gone twice to the water-closet, with

assistance; and had pronounced his own name. Pulse 88,

full, and firm. Continued the medicines and Vest.

10th.?He had much improved, and could occa

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QUEEN'S HOSPITAL, BIRMINGHAM. ^\ H

sionally answer questions correctly. Also he had in a

slight degree recovered the power of the right arm and

leg. Continued the medicines.

14th.?He was sitting up, and could move both arm

and leg a little, but had a stupid and idiotic appearance. Continued the medicines.

17th.?Still improving, could answer simple ques

tions, and could walk with assistance, dragging his right

leg. Continued the medicines.

24th.?The calomel and aperient were omitted, and

he took sulphate of zinc three times a day, and blue

pill and colocynth every night, while he rubbed in a

stimulating liniment. At this state he walked out in

the grounds with a stick, hanging his right arm, and

dragging his right leg. 28th.?Still improving, but some dragging of the

right extremities continued, with dulness of intellect

and imperfection of speech. Appetite very keen. He

now began to take phosphate of iron, instead of sul

phate of zinc.

Up to the 4th of March little change occurred. He

then left the hospital in a fat and hearty condition.

His speech was still thick, his tongue was protruded towards the left side, and all the powers of the other

side remained impaired, yet he could raise his right arm to his head, walk quickly with a stick, and could

make himself generally useful, although he had lost

much of his natural vivacity.

Such cases are always doubtful in their results, but

the remedial measures were in this case so far successful,

consisting chiefly in the use of derivants, and such

agents as abate inflammation, and promote absorption; and what appears to be of great importance, the enforce

ment of perfect quietude, not admitting even of any

unnecessary interrogation, which instead of improving the patient by rousing him, only injure and disturb him

by the cerebral exertion called forth.

In this case was the remarkable, but hitherto unac

counted-for symptom of answering "yes11 to every

question.

Case of Carcinoma of the Pylorus.

Dreadful as is this malady, when seated externally and where it is frequently amenable to surgery as a

palliative or curative means, still more fearful is it, when an internal organ is the seat of attack, particularly when the tumour is so situated as not to produce

symptoms clearly indicative of its presence, thereby con

cealing its nature until remedies are of no avail. In

this case the tumour occupied the pylorus, but could be felt only sometimes, and some examiners who did

not feel it denied its existence; hence the importance of a close examination, especially by palpation as a con

firmation of the diagnosis founded on other symptoms, as is illustrated in the following case:?

Joseph Shay, aged 48 years, of bilio-nervous tem

perament, a hawker, became an in-patient of the Queen's

Hospital, Birmingham, under the care or Dr. David

Nelson, on the 25th of October, 1850.

He stated that his illness was of four months' dura

tion, and complained chiefly of constipation and persist tent vomiting after taking food.

He declared that he had been a regular liver, and

had travelled much in the open air in his vocation; but a gentleman was present in the ward who recognised him, and affirmed that he had been an inveterate dram

drinker; this was confirmed by his relatives, who

reported him to have led a very abandoned life, being

frequently drunk upon rum for several successive days, without tasting any kind of food. He was very thin ; countenance of a straw-coloured sallowness, which, with,

the wrinkles of his forehead, made him appear older than

he was. He had a dry cough; but the pectoral percus sion was good and the heart's sounds natural. The

tongue was pink and furrowed; the vomiting continued as previously, and the constipation yielded only to

aperients. There was tenderness of the epigastriumr and something hard could be sometimes felt in the region of the pylorus. The skin possessed a natural degree of heat; pulse 100, small and weak.

Diagnosis.?Scirrhus or cancer of the pylorus. Indications.?To relieve local congestion and allay

irritability.

Treatment.?Application of leeches over the epigas trium and the administration of an aperient pill every

night, with a draught of calumba, bismuth, conium,. and opium, thrice a day. Ordered mild food in very small quantities.

28th.?The vomiting was only slightly relieved;

cough continues; pulse 78; continue the medicines.

November 1st.?He became worse, all food and

medicine being rejected as soon as taken, the bowels were moved almost hourly, and the foeces were dark ;

tongue remains furrowed; pulse 100. Four more?

leeches were applied, and nothing but hydrocyanic acid

administered.

5th.?Tt was reported that the stomach rejected'

everything. He had also shooting pains; and on this

day Dr. Nelson, with the resident officers, distinctly felt a hard tumour in the pylorus. It was not so easily

distinguished at other times. He was ordered a draught of hydrocyanic acid immediately, and an injection of

tincture of opium, also brandy in small doses.

8th.?He vomited once and twice the day before ? but had severe purging. He took acetate of lead with

opium, and his diet was to consist of mutton broth, thickened with rice.

9th.?He continued much the same as to sickness^

and purging. Medicine continued.

10th.?He was manifestly weaker; and on he 11th. was extremely low, scarcely took anything, very indifferent to conversation, and was evidently sinking

rapidly. He died on the same day, at six p.m.

Autopsy.?The body was emaciated and straw

coloured ; the texture of the heart looser than natural ; but the lungs and pleura were perfectly healthy. The

pyloric end of the stomach was found to be a large thickened mass, corrugated and lobulated externallyr and formed of a carcinomatous deposit, ulcerated at the

inner mucous surface, with here and there patches of

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12 VISITATION OF PRIVATE LUNATIC ASYLUMS.

inflammation. The disease extended two inches up into

the cavity of the stomach, and about the same length down the duodenum. There was a regularly defined

margin round the whole circumference of this mass on

the mucous surface; and the rest of the stomach and

duodenum beyond this margin looked healthy. The

liver was pale and fatty, but not enlarged. The bowels

and kidneys appeared natural, and the spleen was only a little turgid.

This seems to be one of those cases in which cancer

is fairly attributable to frequent large potations of raw

spirits upon an empty stomach; whatever else the

deposit of cancerous matter may be dependent on, it seems clear that it is generally developed in parts

which are the seat of chronic irritation, in conjunction with pressure or constriction. Hence, apparently, its

frequency in the neighbourhood of the pylorus. The emaciation, the straw complexion, and the

vomiting, were the chief subjective symptoms that led to the diagnosis, and the discovery of the tumour re

moved all doubt. Yet, so very obscure was this

physical sign, that it was frequently not felt, and seemed to have escaped the notice of those who had previously treated him. It was deep seated, and felt like a floating ball within a bladder full of fluid, against which the

finger could only impinge, and'then it was lost. The best way of detecting its presence, was to place the

fingers on the skin, and by a sudden descent they were felt to come in contact with a body resembling a seg

ment of a hard ball, which so yielded that it conld not be pressed. No treatment, of course, could have been of any avail at such a stage of the disease. To allay irritation was all that could be done.

^rnnitirial 3?tMtil k Ittrgiutl Smtnuil.

WEDNESDAY, JANUARY, 7, 1852.

Ik the preceding numbers of this Journal

will be found two letters on the subject of the

inspection at present exercised in regard to pri vate lunatic asylums, one by Mr. Perceval, the

Secretary of the Lunatic's Friend Society, con

taining some sweeping charges against all pro

prietors of these Institutions, the other a courte

ous and well-timed reply by a Member of the

Council of the Provincial Medical and Surgical Association.

The subject is undoubtedly one of great im

portance. In our private asylums are confined

the relations and friends of many families of

distinction in the country; indeed, of scarcely any circle can it be said, that no one member is

t ius afflicted, or likely to be so visited amid the

many changes which sadden life's varying

scene. And the inmates of these institutions,

too, are people touchingly dependent upon us all

for support and protection. They are, to use

the words of a recent writer, "

abiding in a

region where but few rays of hope enter, and are

borne along in a course which has no bright

horizon such as generally dawns on the elastic

minds of the sane, amid the greatest troubles.

And yet they are brethren: carried onwards with

us by the same river ever flowing towards the

ocean of eternity; their bitter cries rise up on

high mingled with our careless voices, and both

the plaints of the one and the insensibility of the

other, are registered there."

The private asylums so indiscriminately abused

by the self-styled lunatics' friend party, are

divided into two distinct classes, the one owned

by medical men?many of them of high character

both professional and general,?the other class

by lay proprietors, who treat their poor patients,

much as the lay impropriators treat the immortal

souls in their parishes,?as mere objects of traflic

and gain. For these latter and the entire system

connected with them we have no word of defence.

Indeed, thanks to the able efforts of Her Majesty's

Commissioners in Lunacy, the system of lay

licences for the purpose of farming out from

unions and needy or, it may be, greedy relatives,

the insane to board and clothe, is becoming one

of the things of days gone by. Till the system be entirely abolished, Mr. Pekceval may write

without let or hinderance from us.

Of the first class, on the other hand, the

houses kept by professional men of experience

in this department of medicine, we can, from ex

tensive personal observation, speak in the highest

terms of approbation. In any suggestions, there

fore, for their better regulation which we may

now offer, the friendliness of our motives cannot

be misunderstood.

Such institutions are at present visited half

yearly by the Commissioners of Lunacy, and

quarterly by the Visiting Justices of their re

spective* counties. At these visitations, the

patients are each individually seen, all certificates

are examined, and the various domestic arrange

ments of the house inspected. Yisits, however,

at such long intervals and with so little acquaint ance with the minute economy of the establish

ment, cannot be productive of that active super

intendence which can alone ensure perfect ob

servance of the recommendations which the Com

missioners may find it necessary to make. In

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