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On boiling, this mixture became in a few minutes jet black. This proof of the presence of sulphur was conclusive as to the nucleus of this calculus being cystine.
The layers exterior to this nucleus contained no cystine; when treated with nitric acid they gave evidence of uric acid, which was combined with ammonia, being soluble in water, and evolving ammonia when heated with liquor potassae. By heat, a considerable residue was left, which dissolved with effervescence in dilute acids, and afterwards gave a larger precipitate of lime. By long-continued heat an alkaline ash remained. Hence the external part of the cut surface consisted of urate of ammonia and oxalate of lime.
The external surface of this calculus also appeared to consist of two substances, a white crystalline superficial part, and an inferior brownish yellow substance. The first consisted of crystals of oxalate of lime, the second of urate of ammonia and oxalate of lime.
Hence the cystine deposit continued for a considerable time, and was succeeded by urate of ammonia and oxalate of lime for a comparatively short time, and this was followed for a still shorter period by oxalate of lime alone.
Through the kindness of Mr. Hawkins I am able to give the history of this calculus, which he removed from James Roberts, 6£ years old, at the Asylum for the Recovery of Health, in 1828. The boy had suffered from symptoms of calculus for four years. The pain occasionally was so great that he was held up by his feet to give him relief. The operation was performed on the 25th of October, and the wound healed on the 6th of December. He returned to Cornwall, and nothing has since been heard of him.
This case proves the existence of a deposit of cystine so early as two years of age. It has not as yet been found in a patient of more than 47 years. Of the ten cases recorded by Dr. Prout, eight occurred between 47 and puberty. One before 12 years of age, and one before the patient was five years old.
ULCERATION OF THE INTERNAL JUGULAR VEIN,
COMMUNICATING WITH AN ABSCESS.
By WILLIAM BLOXAM, Esq.,
Surgeon To Queen Adelaide's Lying-in Hospital, And Lecturer On Midwifery At The School Of Anatomy And Medicine Adjoining St. George's Hospital.
Communicated By SAMUEL LANE, Esq.
READ FEBRUARY 28th, 1843.
As the following case appears to be one of an unusual character, if not unique, I take the liberty of presenting it to the notice of the Royal Medical and Chirurgical Society.
On the 20th of October 1842, I was requested to visit a child in the neighbourhood of Golden Square, who had been under the care of a medical gentleman for three weeks previous with an attack of scarlatina. On the decline of the eruption, one of the glands on the right side of the neck, under the angle of the jaw, became inflamed, and suppurated freely.
This abscess had opened itself externally for five days, when a discharge of blood took place from the aperture, small at first, but becoming gradually more copious and of a venous character.
Three days after the first appearance of the blood I saw the case.
The child, five years of age, was very pale; indeed, I might say almost exsanguine; her pulse rapid, extremities cold, and the haemorrhage existing to a great extent. This was much aggravated by coughing or moving, and being a child of extraordinarily irritable temper, every time she was excited the blood poured forth in an alarming manner.
Having consulted with the gentlemen who were in attendance on the case, we agreed to plug the abscess with lint, and to endeavour to restrain the bleeding by pressure.
This was done: a graduated compress and roller were applied, and the haemorrhage then ceased, and did not return for twelve hours; when, in the evening, the child became very restless and intractable, and consequently the haemorrhage recurred: and, though the compresses were several times re-adjusted, she was so irritable that they were almost immediately displaced.
This state of affairs continued from time to time, and the child died on the fifth day from the first occurrence of the haemorrhage.
On examining the neck after death, an immense quantity of semi-coagulated blood was effused beneath the integuments of the throat and fore part of the chest.
The abscess was carefully laid open, and the internal jugular and carotid artery were transversely divided some distance lower down the neck ; and on passing a probe upward to the abscess, an ulceration of an oblong shape, of about five lines in its long axis, was observed in the inner side of the internal jugular vein, opening immediately into the sac of the abscess.
Vol. xxvi. I