On the origin of inflammation of the veins / and of the causes, consequences, and treatment of purulent deposits

by M.D. Henry Lee

D. CASES IN WHICH VITIATED FLUIDS WERE OBSERVED IN THE VEINS OF THE UTERUS AFTER CHILD-BIRTH.

Case xxxi.[45] On the second day after a natural labour, a woman had prolonged rigors, which were followed by abdominal pain and much perspiration. On the fourth day, she was affected with syncope and bilious vomiting, accompanied by extreme prostration. On the fifth day, the abdominal pain, which had subsided, re-appeared with agitation and delirium. On the sixth, she had cold sweats, irregular pulse, rapid breathing, and vomiting. She died on the following morning.

Post-mortem appearances. There was a small quantity of limpid serum in the cavity of the peritoneum. Some of the uterine veins were found to contain a turbid fluid. The heart was half filled with brown blood. The lungs were congested, and the other organs natural.

Case xxxii. A woman, twenty-two years of age, of a nervous temperament, miscarried at the expiration of the first month. She was almost immediately afterwards attacked by rigors and bilious vomiting, accompanied by pains in the loins and in the hypogastrium. On the following day, there was coma, with indications of extreme debility. On the third day, consciousness returned. There was difficult articulation, and moaning. The extremities became cold, the pulse imperceptible, and death occurred upon the same day.

Post-mortem appearances. The peritoneum was slightly injected, and contained a small quantity of reddish serum. The cervix uteri was covered with a layer of pus. Semi-transparent lymph was found in some of the uterine veins. The brain, and other organs, were found healthy.

Case xxxiii. A feeble girl, 21 years of age, was confined at the expiration of the eighth month. On the fourth day, there was shivering and prolonged fainting. The following morning, she had acute abdominal pain, fever, and diarrhœa. On the seventh day, the symptoms had all subsided, but on the eighth the abdominal pain returned, accompanied by syncope. She died two days afterwards.

Post-mortem appearances. The peritoneum was slightly injected, and contained about a pint of red-coloured serum. The uterus was large, white, and firm, its veins half filled with fluid blood; its lymphatics natural; its inner surface lined with a layer of fetid brown blood, but otherwise healthy; the cervix covered with a grey, thin exudation. The lungs, heart, brain, and other organs, were quite sound.

Case xxxiv.[46] Anne Biggs, æt. 39, confined March 18th, 1830, eighth child. On the evening of her confinement, her manner was much excited. On the 19th, she was incoherent, and complained of pain in the calf of the right leg, which was tender on pressure. The pulse being hard, she was bled to eight ounces. On the 28th, the leg was swollen and white; the pain in it much increased: towards evening the calf of the limb became black, while, at the tendo-achillis, the skin was hot, tender, dry, and mottled. The bowels were much opened, the head giddy, the pulse quick and strong. She was again bled, to twenty-six ounces, and twelve leeches were applied to the temple. On the 21st, there was nausea, vomiting, and diarrhœa. On the 23rd, she complained much of the confusion in her head, the leg was tolerably easy, but the upper and inner part of the thigh was very tender. On the 24th, the diarrhœa continued, and there was increased weakness. A hard swelling, about half as large as an egg, appeared at the wrist, and one of the orifices made by venesection was black and painful. She died in the evening.

Post-mortem appearances. All the ventricles of the brain were dilated with serum, and there was a good deal of effusion into the arachnoid and pia mater. The viscera were perfectly healthy, except the heart and spleen: the latter was very large, and on pressing it, a large quantity of dirty red pulpy matter exuded. The lining membrane of the right auricle and ventricle, when washed, had a dark red hue. The femoral vein, just at the ingress of the saphæna, and the superficial vein in the back of the leg, had their coats much thickened, so as to cut like arteries. Their lining membrane was similar to that of the right cavity of the heart. When they were divided, purulent matter, mixed with thin light-coloured blood, escaped. The cellular tissue forming the sheath of the femoral vessels, and on the calf of the leg, shewed marks of recent inflammation; but there was no appearance of pus in these situations. None of the glands in the groin or ham were enlarged. The inferior vena cava appeared healthy.