E. CASES OF PURULENT DEPOSITS, CONNECTED WITH INFLAMMATION OF THE VEINS AFTER DELIVERY, RECORDED BY DR. ROBERT LEE IN THE MED.-CHIR. TRANSACTIONS.
Case xxxv. Mrs. Mayhew, æt. 33, was delivered on the 2nd March 1829. On the 5th, there was a discharge of blood from the uterus. From the 6th to the 20th, she made no complaint of uneasiness in any region of the body, though her strength rapidly declined. The countenance was of a dusky yellow hue. The heat of the surface slightly increased; the respiration hurried, particularly on bodily exertion, and the pulse above 130, and feeble; the tongue pale and glossy, with loss of appetite. The lochial discharge had a peculiarly offensive smell. She died upon the 28th of March.
Post-mortem appearances. When the uterus was laid open, there was found to be a portion of the placenta, about the size of a nutmeg, in a putrid state, adhering to its inner surface. The substance of the uterus, to the extent of an inch around this, was of a peculiarly dark colour, almost black, and as soft as a sponge. On cutting into it, about a teaspoonful of purulent matter escaped from the veins, and a small additional quantity was pressed out from them.... On opening the capsular ligament of the right knee-joint, about six ounces of thin purulent matter escaped, and the cartilages of the femur and tibia were extensively eroded. There was no appearance of inflammation, however, on the exterior of the capsular ligament. The right wrist was swollen, and the cellular membrane around it was unusually vascular, and infiltrated with serum.
Case xxxvi. Mrs. Pope, æt. 40, was delivered, on the 26th of Oct., of her fourteenth child, and appeared to recover favourably until the 3rd of Nov., when she was suddenly attacked with a severe rigor. This was followed by intense head-ache, vomiting, general soreness of abdomen, and suppression of lochia. Nov. 6th. Great prostration of strength; laborious respiration, with pain at the bottom of the sternum, and frequent hacking cough; pulse 135, extremely feeble; skin hot and dry.... Occasional retching and vomiting. Several hard, lumpy cords were found running up in the inside of the thigh, in the direction of the superficial veins. 7th. Delirium; general debility greatly increased; the surface of the body was covered with a yellow suffusion; the middle finger of the left hand was much swollen around the second joint, and the skin covering it was of a dusky red colour.
Case xxxvii. Mrs. Edwards, æt. 35, was suddenly attacked, three weeks after delivery, with pain in the calf of the right leg, and loss of power in the whole right inferior extremity. On the 5th day from the attack, a considerable swelling, without induration, had taken place from the ham to the foot, and great tenderness was experienced along the inner surface of the thigh to the groin. The extremity became universally swollen, painful, and deprived of all power of motion. The temperature along the inner surface of the limb increased; the integuments were pale and glistening, not pitting upon pressure. The femoral vein, from the groin to the middle of the thigh, was indurated, enlarged, and exquisitely sensible; pulse 80; tongue much loaded; thirst; bowels open. On the 23rd day from the attack, the disease was apparently declining. The femoral vein could no longer be felt, but there was still a sense of tenderness in its course down the thigh, and she experienced considerable uneasiness between the umbilicus and pubes, as well as in the loins. She now, for the first time, began to have rigors, accompanied by a quick pulse, loaded tongue, and thirst. From this period to the 31st day, the swelling of the limb and tenderness in the course of the femoral vessels subsided, but she experienced attacks of acute pain in the umbilical region, loins, and back, which assumed a regular intermittent form. Every afternoon there was a rigor of an hour's duration, followed by increased heat, and profuse perspiration: the skin was hot and dry; pulse 125; tongue brown and parched; bowels open. These febrile attacks gradually declined in severity, and she appeared to recover till the 43rd day, when she had a long and violent fit of cold shivering. The countenance now became expressive of great anxiety, and the pulse extremely weak and feeble. 45th day. Vomiting; pain upon the left side, increased upon taking a deep respiration. 46th day. Another severe and prolonged rigor; skin hot and dry; pulse 140; tongue brown and parched; diarrhœa; respiration hurried, with frequent cough; surface of body presenting a peculiar yellow tinge. The conjunctiva of the right eye now suddenly became of a deep red colour, and so much swollen, that the eyelids could not be closed. On the day following, the left eye also became red and swollen, the surface of the body was cold and clammy, pulse 140, extremely feeble, with great debility, and repeated attacks of vomiting. From this date, the patient lived nearly three weeks, but for the last fortnight the vision in both eyes was entirely destroyed.
Post-mortem appearances. The left pleural cavity contained upwards of two pints of a thin, purulent fluid. The inferior lobe of the left lung was of a dark colour, and soft in texture. In its centre, about an ounce of thick cream-coloured pus was found deposited in its dark and softened texture. This was not contained in any cyst or membrane, but was infiltrated into the pulmonary tissue. The coats of the vena cava inferior were considerably thickened; its whole cavity was occupied by a coagulum, terminating above in a loose pointed extremity. The left common iliac vein was plugged up, by a continuation of the coagulum from the cava. The coagulum was continued beyond the entrance of the internal iliac, which it completely closed, and terminated in a pointed extremity about the middle of the external iliac. Neither the remainder of the vessel, nor the femoral vein, exhibited any morbid changes. The right common iliac vein was contracted to more than one-half its natural size; it was firm to the touch, of a greyish blue colour; to its internal coat adhered an adventitious membrane of the same colour, containing within it a firm coagulum. The internal iliac was rendered quite impervious by dense, dark coloured bluish membranes; and, at its entrance into the common iliac, it was converted into a solid cord. The contracted external iliac contained within it a soft yellowish coagulum; its coats were three or four times their natural thickness, and lined with dark-coloured membranous layers. The right femoral vein, from Poupart's ligament to the middle of the thigh, was diminished in size, and almost inseparable from the artery. Its tunics were thickened, and its interior coated with a dense membrane, surrounding a solid purple coagulum strongly adherent to it.