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CASE

OF

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 hæmorrhage 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 hæmorrhage then ceased, and did not return for twelve hours; when, in the evening, the child became very restless and intractable, and consequently the hæmorrhage 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 hæmorrhage.

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

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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.

The perforation, which may be seen in the preparation accompanying this paper, furnishes a satisfactory explanation of the source and quantity of the hæmorrhage.

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THE cases I have ventured to lay before the Society occurred in a charitable institution for the maintenance and education of female children from the age of nine to fourteen, and may, perhaps, derive interest from their having been observed and treated with the strictness so difficult to accomplish, except within the walls of a public institution.

The cases, seventeen in number, occurred in two groups; the first commencing in February 1841, preceded by well-marked pyrexial symptoms; the second in October last, in which the hysterical and imitative character was evident from the first. The children attacked were from eleven to fourteen years of age.

In February 1841, one, and shortly afterwards seven of the children were attacked as follows

with a short and almost constant hacking cough, with much pain and distress in breathing, but no expectoration; quick pulse, hot skin, white tongue, and costive bowels. After two or three weeks, during which time these symptoms withstood all the remedies applied, the cough changed to sounds varying in the different patients; in some, resembling the double action of a large saw; in two, a shrill screaming expiration, following a quick catching inspiratory effort, much resembled the cry of a peacock; in another, the sound was such as is produced by blowing into a small metallic tube. In fact, it is difficult to conceive the dissonance and constancy of these sounds.

Besides these, one girl, aged fourteen, became affected, at the same time, with symptoms exactly resembling those of laryngitis, and requiring the usual means for their removal; but they were followed after a week or two by the sounds above described.

In the commencement, sinapisms, blisters, combined with the administration of expectorants and sedatives, with and without the addition of antispasmodics, were tried without avail. A combination of extract of hemlock, sulphate of zinc and of quinine was given, as well as full doses of sesquioxide of iron, when the anomalous sounds were established, which produced no effect, although continued for a considerable period, until the children were separated one from the other, when with the exception of two, who were sent to their homes

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