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I found on inquiry, that at this time the complaint was confined to a narrow line of this and the neighbouring district. For some days, I saw and heard no more of it, till perhaps a week afterwards, when I was at the furthest extremity of the town visiting an hysterical patient who had symptoms of the same disorder. I was called to see Mirza Saleh, who had been discovered lying in his own room, insensible. When I arrived, he was beginning slowly to recover his senses, and could be roused a little: but as he continued drowsy and stupid, I ordered him an enema of 5U of assafcetida, and left him for a while. As no one had seen him at the commencement of the attack, I could not learn whether he had been seized with spasms or not. On my return two hours afterwards, I found him talking of his grievances in English with the Hakim Mirza Baba, in a very excited manner. I recommended him to take two doses of iron, and he had no return of his symptoms.
It was not till the 25th of February, and in another distant quarter of the town, that I saw another case of this complaint. On the evening of that day, on coming home, I found a note from Dr. Kapherr of the Russian mission, begging me to
come without delay to see M. B , a French
officer, commandant of a detachment in the service of the Shah. The commandant is a man of very quiet habits, aged about forty-five. Head rather large and neck short. I found him on my arrival in a state of insensibility, the mouth drawn to the left side, and that side of the body paralytic. He had been in this state about six hours, but little account of his state previous to the attack could be collected from his servants. The pulse was rapidly sinking and nervous—now quick and irritable, now soft, weak and scarcely perceptible. A few teaspoonsfuls of aether, sulph. co. were given, and some 5 or 6 ounces of blood drawn from the arm, after which the pulse became steady. He now had an enema of 3ij of assafcetida, which was retained—and he continued in the same insensible paralytic state till 2 a.m., having been comatose for about fifteen hours. He then awoke as from a sleep, and walked to stool. In the morning I found him perfectly sensible, and nothing remaining of the paralysis but a sense of weariness in the limbs. He then took ol. ricini gifs, and had no return of his complaint. According to his own account, early in the morning he had been seized with the most urgent desire to make water, but found himself unable to do so— he continued to make frequent attempts in vain, and the agony of the urgency he describes as insufferable, until he lost his consciousness (apparently about 11 a.m.). When the injection operated, the water came without difficulty. He had no subsequent headache, nor any premonitory symptoms, such as sleeping of the hands or feet.
At another time, I should have considered this an attack of apoplexy, which from his appearance one would esteem very probable. But taken along with the previous cases, and considering his general health, both before and after the fit, I think it may, without doubt, be classed with those I have described. This was the last case of this disease which I heard of.
THE NATURE OF THE
OSSIFICATION OF ENCYSTED TUMOURS.
By JOHN DALRYMPLE, Esq.,
SURGEON TO THE LONDON OPHTHALMIC HOSPITAL.
READ JUNE 13th, 1843.
On the 28th of April I removed a small tumour from beneath the tarsal cartilage of the upper eyelid of a middle-aged man; which, instead of the usual cheesy matter, contained an apparently earthy or bony deposit. This tumour was somewhat larger than a pea, and composed of concentric layers of hard earthy material, and in form was rounded, except at the surface, immediately behind the conjunctiva, where it was somewhat flattened and rough. From its pressure it has caused absorption of the cartilage, and ulceration of the conjunctiva; hence the friction of its rough surface produced much pain, inflamed the conjunctiva scleroticae, and rendered the upper part of the cornea opaque.
Upon examination by the microscope, the concentric layers of this tumour were found composed entirely of epithelium scales closely agglutinated together: but instead of the usual transparent and thin lamina with its central nucleus, they were thickened and hard, and contained granular earthy molecules, which could be removed by immersion in weak muriatic acid. No amorphous earthy deposit existed around or among the scales, but the whole was composed of this epithelium, opaque, of a light brown colour, with a clear and large central nucleus.
The sebaceous or cheesy matter of encysted tumours, it is well known, consists of desquamated epithelium, somewhat disintegrated and mixed with oily globules; but here the mass may be said to have been ossified epithelium, or, in other words, these cells were filled with granular earthy deposit.
In structures ordinarily denominated ossified, it is probable, no true bone will be found to exist, except in those connected with original bony or cartilaginous tissues.
This case is interesting, in so far as I am unaware of any similar observation in regard to epithelium cells; and it adds one fact to our at present scanty information on the subject of cell secretion.
Mr. Bowman has recorded the great increase of oil globules in the cells of fatty liver; and Mr. Gulliver of biliary matter in the epithelial cells of the same organ affected with jaundice. But in both these instances the morbid condition consisted of an increase of what originally existed in a normal state,