Injection of Saline Solutions into the Veins.

(Continued from page 55.)

No. 4.

Letter from Dr. Lewins, to the Secretary of the Central Board of Health.

Results of the Injection Practice in the Drummond-street Cholera Hospital, Edinburgh.

Sir,—You will receive from Dr. Latta, the details of two or three cases treated by saline injections. We have both been so much occupied to-day, that we have not had leisure to get our communications ready to be sent in the same envelope. We steal an hour from the time usually allotted for rest to write to you. In case Dr. Latta should omit to mention the circumstance, I beg to mention that his patient, Cousins, the woman who was injected to the amount of three hundred and seventy-six ounces, and who promised to do well, for a considerable time, was a person of very dissipated habits.

In the Drummond-street hospital six patients have been injected, and three recovered, or are recovering. In the three that died, extensive organic disease was found on dissection; disease that had existed previously to the attack of cholera.

I send herewith the report of two cases, treated by Dr. Craigie of this place, which, at my request, he furnished me to-day for the perusal of the Board.

I intended to have sent an account of an interesting fatal case, the only one in which the venous injection may be said to have fairly failed where it was fairly used; that I shall do to-morrow.

I have the honour to be, sir, your most obedient servant.

ROBERT LEWINS, M. D.

Leith, May 27th.

No. 5.

Details of Two Cases of Malignant Cholera treated by Venous Injection, by Dr. Craigie, of Leith.

No. 1. Case successful. 15lbs. injected at intervals in nine hours.—Martha Smith, aged thirty-eight, a noted drunkard, thin and debilitated, in sixth month of pregnancy, admitted into the hospital at 8 P. M. May 16th, 1832.

It appears she had had vomiting and purging since Sunday morning, 12th inst. Cramps came on about four hours ago in both legs; great evacuations both upwards and downwards like dirty water. The countenance is now collapsed; eyes sunk; tongue cold; pulse imperceptible at wrists; very small in brachial artery; 124.

℞. Muriat sodæ, ℨiij; Carbon sodæ, ℨi; Aq. calid. ℔vj. solve. Ft. Enema statim injiciend. Sinapisms to spine and epigastrium; let her be placed on heated tin mattress.

Nine A. M. Has a good deal of vomiting; is getting warmer; pulse now perceptible in right wrist; tongue warmer; she allows the enema to come away without giving notice to nurse. Saline enema as above, with the addition of white of eggs, to be repeated every half hour.

Ten. Vomiting and purging of watery fluid, with slimy matter in it.

Half-past ten. Cramps have returned severe in left leg; pulse again imperceptible; urgent thirst, and constant vomiting. Rep. enema et pulveres effervescentes.

Half-past eleven. Breathing becoming much affected; extreme restlessness; cramps severe in legs, and every symptom of sinking. Let the following saline solution be injected into one of the veins of the arm.

℞. Muriat sodæ, ℨi; Carbon sodæ, gr. x; Aq. calid. ℔iij, solve temp. 105° Fahr.

Noon. When about ℔i. had been thrown in, the pulse was perceived to flutter at the wrist, and gradually strengthened as the injection was proceeded with. By the same ℔iiiss. had been injected, the countenance, which was before quite death-like, now beamed with the appearance of health, and she began to converse freely. Pulse 96, moderate. To have ℥i. gin in warm water with sugar.

Half-past one. The gin was immediately rejected. Pulse has again gradually become imperceptible, and respiration quick and laborious.

Two. Let the venous injection be repeated to ℔vij.

The effect of the injection, as formerly, was very striking. To see an individual who seemed in articulo mortis brought back, as it were, in so short a space of time to an apparently tolerable state of health, could not but astonish the beholder. Before the injection was finished the pulse had returned to a healthy fulness and firmness. Expresses herself much relieved; no purging, but vomits much serous matter.

℞. Muriat sodæ, ℨij; Carbon sodæ, ℨi; Alcohol. dilut. ℥i; Aq. calid. ℔iij. M. ft. enema statim injiciend.

Four. Enema retained about an hour and a half; surface of body now comfortably warm; she has not passed more fluid by stool than was thrown into the rectum.

Six. Has slept softly for an hour; the first sleep she has had for many days.

℞. Subm. hydrarg. gr. v; Pulv. opii, gr. ss. M. sumat stat. et rep. 3tia quaque hora.

Nine. Complains much of vomiting and sense of weakness; countenance rather collapsed; breathing rather difficult.

Let ℥lxxx. be injected into the veins again gradually.

After the first few ounces were thrown in she complained of an acute pain at the epigastrium, and faintness, probably arising from the fluid being thrown in too fast upon the heart, or from the passing of a bubble or two of air, which may have got in from the inaccuracy of the injecting apparatus used. Be that as it may, the circulating system was so much affected, that the pulse, from being distinct though feeble, became quite imperceptible, but on stopping the injection for a few minutes the pulse gradually returned, and the pain abated. She expresses herself as always getting relief from the operation.

Eleven. Vomiting continues urgent.

App. emp. cantharid. epigast. Effervescing draughts occasionally.

May 17th. Has passed about ℔j. of urine, of natural appearance; this is the first she has made since she was brought in.

From this time she went on gradually to improve, but stomach continued very irritable, and the matter vomited was bilious.

21st. Labour pains came on, and she was delivered of a still-born female child.

22d. Symptoms of phlebitis in right arm came on, proceeding from the wound upwards, but this yielded to the ordinary treatment, and she may now be considered out of all danger, though she is not yet reported cured.

THOMAS CRAIGIE, M. D.

Leith, May 26th, 1832.

No. 2. Case fatal—appearances on dissection.—George Cousins, aged ten, was brought into quarantine at nine, A. M. 13th May, on account of his mother being ill of cholera. About an hour after admission began to vomit and purge, and it appears he has had diarrhœa severely all the morning. Pulse 102, extremely weak; complains much of sickness; countenance collapsed; areolæ rather dark under the eyes; voice very weak.

He had hot air-bath immediately, and got the following dose:—

℞. Ol. ricini, ℥ss; Tinct. opii, gtt. xv; Aq. menth. pip. ℥iss. M. ft. haust.

Half-past eleven, A. M. Draught retained; sickness has gone off; complains of heat of bath; let it be removed.

Noon. Has vomited some watery matter, with undigested potatoes in it, and again a rice-watery fluid with flocculi. He has now a considerable degree of jactitation; countenance more sunk, and great desire for cold water. These symptoms went on increasing in severity in spite of sinapisms to spine, effervescing draughts, calomel, and Dover’s powder, warm water, enemeta, &c., and head symptoms were now making their appearance.

Half-past two P. M. Pulse quite imperceptible, and has been so for an hour and a half; he lies quiet and drowsy, with eyes turned upwards; face bedewed with cold perspiration; hands and feet cold and very blue.

My colleagues, Drs. Combe and Lewins, saw him with me at this time, and concurred with me in thinking him not only beyond all hope of recovery, but likely to die within an hour or two.

From what I had seen of the resuscitating powers of Dr. Latta’s treatment on the boy’s mother this morning, by venous injection, I determined on giving it a trial, though this was a case rather likely to bring discredit on the remedy than otherwise. The following solution, at temperature 102° F. was slowly injected into the median basilic by means of a common silver blow-pipe attached to Reid’s enema syringe:—

℞. Muriat sodæ, ℨi; Carbon sodæ, gr. x; Aq. calid. ℔vj. solve. T. 102.

Three P. M. A few minutes after the injection was commenced the pulse returned to the wrists, the blueness and coldness of the extremities gradually wore off; the countenance was much improved; and the whole fluid was injected within twenty minutes.

Half-past three P. M. He has now a healthy, blooming appearance; is sitting up in bed, and looking about him as if awoke out of a dream. Pulse 110, natural; extremities of good colour and warm; voice much stronger.

Half-past four P. M. Pulse has been gradually falling off since last report; is getting listless, and dislikes to be troubled with questions, breathing becoming laborious, and head symptoms more marked, with squinting to a slight degree superadded.

Seven P. M. Pulse again imperceptible; respiration quick and laboured; countenance collapsed; tongue and breath cold; says he is dying.

Let the venous injection be repeated to ℔iij.

Half-past seven P. M. Pulse immediately returned, of natural strength and fulness, and continues so.

Nine P. M. Lies very quiet; pulse good; breathing more natural; surface of body covered with warm perspiration.

Ten P. M. Large watery evacuations from the bowels came on soon after last injection; the quantity cannot easily be guessed, but must have been considerable, as it is running through the mattress on the floor. Pulse scarcely perceptible; screams loudly like a child in hydrocephalus.

Eleven P. M. Pulse quite imperceptible; is sinking fast; venous injections attempted a third time, but desisted from as it was not productive of the first good effects. Both pupils much dilated. Died at two A. M. 14th.

Dissection fifteen hours after death.—On exposing the brain and spinal marrow, but before opening their investing membranes, the least pressure with the fingers on the middle of the hemispheres of the brain caused a remarkable undulating down to the middle of the back, showing the existence of a fluid beneath the membranes, and on opening them about two drachms of pure serum flowed out.

The surface of the brain was rather vascular, and the blood in the most minute vessels particularly bright. A few ecchymosed spots on its surface. All the other viscera were found healthy. The urinary bladder contained about half an ounce of urine.

THOMAS CRAIGIE, M. D.

Leith, 26th May, 1832.

No. 6.

List of Queries addressed to Drs. Lewins and Latta, by the Central Board of Health, London, relative to the preceding cases, &c.

QUERIES BY THE CENTRAL BOARD.

1. Were any of your patients bled previously to, or after the saline injections into their veins?

2. Were the evacuations by purging, vomiting, or perspiration, increased by the injections?

3. Did any of the patients submitted to the saline injection plan die; and if examined after death, what were the appearances?

4. Had the pulse at the wrist absolutely ceased, and for how long; or had blueness of the surface taken place, and to what extent, in any of your patients before the injection of the saline fluids; and how many of such patients recovered under that treatment?

5. Had suppression of urine been perfectly established, and for how long, in any of your cases previously to the saline injection, and what effect did that practice appear to produce on the urinary secretions?

6. What effect did the injections appear to have on the temperature of the patient?

7. Were the blood and evacuations analysed before and after the injections?

8. Did consecutive fever occur in any, and if so, in how many of your cases, whether successful or otherwise?

9. Was the quantity of the evacuations noted before and after the injections in any of your cases?

10. Please to give the details of two or three cases treated by saline injections, with age, condition of life, temperament, habits, &c., and particulars of such other treatment as may have been adopted in addition to the saline injections.

ANSWERS BY DR. LEWINS.

1. None before. One to the amount of twelve ounces immediately after the first injection.

2. The evacuations by purging and vomiting, in most of the cases continued. In some of them the purging, the discharge from the bowels at least, was increased. Perspiration was increased in all.

3. Yes; no less than ten of the fifteen that have been injected up to the present day; but under such circumstances as do not detract from the general merits of the practice: this will be made evident by the history of the cases that will be sent by to-morrow’s post.

4. Yes; even at the axilla in some of the cases, blueness of the surface had taken place to a considerable extent. Five of these patients recovered.

5. Complete suppression, I think, in all except two, and for hours. In all the successful, and in some of the unsuccessful cases, the effects of the injection in restoring the secretion of urine were most evident.

6. The injections raised the temperature of the body; but in all the successful cases, where the veins were injected, the patients complained of cold soon after the injection.

7. Neither the blood nor the evacuations were analysed, but I sent some of the blood of a patient that had been injected by the veins, to Dr. Reed for analysis to-day.

8. The consecutive fever in all the patients who were injected, has been slight.

9. No; but they were excessive in most of the cases.

10. Question ten shall be fully answered by to-morrow’s post.

ROBERT LEWINS, M. D.

6 Quality Street, May 26th, 2 o’clock, A. M.

No. 7.

Latest Communication from Dr. Lewins to the Secretary of the Central Board of Health.

Sir,—The urgency of my present private and public duties prevents me from communicating more to you to-night than the following brief particulars of a case that occurred at the Leith Cholera Hospital yesterday:—

A woman of about forty years of age, was admitted on Sunday evening at 7 o’clock. She was pulseless, even at the axilla, sightlesss, cold, and blue, over almost the whole body. Respiration very slow and irregular—in a word, she was all but lifeless. It was feared she would be dead before the operation of injecting could be commenced. Between 7 at night and 2 o’clock next morning, there were thrown in two hundred and eighty-four ounces, upwards of twenty-three pounds. The report of her situation at 2 on Monday morning, in the hospital book, is as follows:—“A change for the better, that appears almost miraculous, has taken place. The action of the heart is greatly improved; respiration not in the least laborious, but quicker than natural; pulse 120, small, but distinct. She can articulate distinctly; countenance natural; lips red; tongue moist and warm; she perspires freely; heat over the whole body natural.”

A full report of this wonderful case shall be forwarded soon.

I remain, Sir, &c.

ROBERT LEWINS.

P. S.—In one, the pulse had ceased at the wrist eight hours before the injection. Dr. Alison had seen the patient eight hours before the operation, and the pulse was then imperceptible.

Quality Street, Leith, May 29th, 1832, 1 o’clock, A. M.