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Public rumour, at the time, accused Lamothe of having committed murder; but it does not seem that it ever reached the ear of the public authorities.
Three years afterwards, the house adjoining to that of Lamothe took fire; and the inhabitants of the village, having never forgotten the tale of Madame Che. valier's death, did not hesitate to accuse her (Lamothe) now of wilful arson.
The magistrates, hearing of these reports, determined to investigate the matter minutely. It was ascertained that Lamothe had some arsenic in her possession at the time of Madame Chevalier's death. They ordered the body to be immediately disinterred-three years exactly having intervened since the period of her death.
The soil of the burying-ground being remarkably dry, the body was found not so much decomposed, as might have been expected. It was forthwith sent off to Paris, to be examined, pathologically and chemically, by Drs. Barruel, Henry, and Olivier-three distinguished men of science in the metropolis. On examining the trunk, it was found completely dry, mummyfied, and almost inodorous; the abdominal parietes, although much shrivelled, were entire. On removing these, there seemed to be no vestiges of the viscera, in consequence of the extreme desiccation, which had taken place. On examining however the parts more attentively, the intestines were found to be reduced to the state of mere membranous laminæ, adhering to each other, and to the spine and edges of the pelvis. In the interstices of these membranous folia, a brownish coloured pulverulent matter was observed. All the viscera, parenchymatous such as the liver and spleen, as well as the fleshy and membranous as the uterus and intestines, had become blended together, just as now described.
At one spot only, on the upper two lumbar vertebræ, there was a small portion of a brown substance, waxy in consistence, which was probably a portion of the liver. After these short details, it is unnecessary to add that it was not possible to distinguish the abdominal viscera, one from another.
A small fragment of the diaphragm, on the right side, still remained. The only vestige of the lungs was a brown friable substance in irregular nodules; and the heart was converted into a hard black and fragile mass, resting on the vertebræ.
The entire contents of the abdominal cavity-if such it can be called-were now carefully scraped from the bones of the spine and pelvis, and collected together, the earthy granular matter being separated from the foliaceous or membranous substance.
The earthy matter was first examined. A portion was boiled in distilled water, acidulated with a small quantity of pure hydrochloric acid.
On cooling, the liquor was filtered. A small quantity of brown deposit was collected on the blotting-paper, and the filtered liquor was of the same colour.
Through a portion of this latter, diluted with water, a stream of pure sulphuretted hydrogen gas was caused to pass for the space of two hours. This gave rise to a light brownish precipitate, which was carefully collected and tested. It gave no traces of any metallic sulphuret, and was found to contain nothing but minute portions of chloruret of sodium, phosphate of lime, and oxyde of iron-the usual salts of animal substances.
The deposit on the filtering paper was then dried and calcined in a crucible; the residue was then examined, and found to contain only the salts now mentioned, and to give no signs of metallic sulphuret. Hitherto therefore nothing had been detected to lead to any suspicion of poisoning.
The shrivelled viscera were now subjected to a most careful examination. They were first macerated in rectified alcohol for forty-eight hours, and then withdrawn. The spirit, which had acquired a greenish brown colour, was filtered and distilled in a glass retort. The residue was concentrated in a water-bath to the consistence of a soft extract, and then treated with slightly acidulated water and boiled. Ammonia was added to neutralise the acid; and then a stream of
sulphuretted hydrogen was passed through the fluid for a length of time. A deep-brown precipitate was formed in consequence. This was carefully collected on filtering paper; and the strained liquor was evaporated to dryness, until a dark brown residue was obtained. On burning a small portion of this on live coals, an empyreumatic animal odour, followed by one resembling garlic, was perceived.
Another portion was then heated strongly with hydrochloric acid, until all the brown matter had disappeared; and the dry product of this treatment, being first neutralized, gave a bright-red precipitate with nitrate of silver, similar to that afforded by the action of this salt on any of the preparations of arsenic.
There were therefore strong suspicions that arsenic would be discovered in the precipitated matter collected on the filter.
It is unnecessary to particularise the experiments, both in the dry, and in the wet method, which were performed. Suffice it to say that they proved, beyond all doubt, the existence of this poison. The Commissioners sent to the public authorities, along with their report, specimens of-1, arsenic reduced to a metallic state; 2, arseniate of silver; and 3, sulphuret of arsenic floating in water.
The Court of Assizes at once pronounced judgment against the woman Lamothe, and condemned her to perpetual imprisonment. This took place on the 17th of March 1837-three years and a half after the death of Madame Chevalier.
In closing this brief report, it only remains to add that the experiments necessary in such a case, as the preceding, require the most patient and protracted care and delicacy. A week, at least, is not too long for such an investigation.—Annales d' Hygiene, &c.
CASE OF TORTICOLLIS, OR WRY-NECK, TREATED BY DIVISION OF THE STERNO-MASTOID MUSCLE.
Dr. Jules Guerin, the author of the following observations, premises them with remarking: Whenever a novel idea is started, it is almost sure to encounter three sorts of opposition-the opposition of the learned, who will not suffer that any thing can be invented or discovered in the present day which has not been known before; the opposition of rivals, who claim to participate in what they have the laudable regret not to have done; and lastly, the opposition of those esprits retardataires, who resist all progress or advance whatsoever.
These three sorts of opposition have all been exhibited against those views on the treatment of wry-neck, which I have recently published. It may therefore be useful to report a few cases from my own practice, as well as from that of other surgeons, in order that medical men may judge for themselves of the soundness of my ideas.
Case 1. The patient, a youth 19 years of age, had been affected with permanent wry-neck since his infancy. Perhaps even it was a congenital malformation; but this point could not be determined in consequence of the want of any exact report.
When admitted into M. Guerin's Orthopedic Institution, the following was his condition.
"The head is bent or inclined to the left side, its vertical axis forming with the angle of the vertebral column an angle of 145°. The face is turned round toward the right side, so that the left angle of the lower jaw is in a line with the sternum, and the chin with the sternal end of the right clavicle.
On examining the left sterno-mastoid muscle, it is found to be-especially the sterno-mastoid portion-tense, contracted, very hard, and prominent.
The whole left side of the face is more or less deformed or irregular; the left eyelids being drawn in towards the nose, and the tip of the nose and the left
half of the lips downwards and to the left side. The cervical column has a very marked leaning to the right side, and the left shoulder is higher than its fellow. The chest too exhibits several irregularities in its symmetry."
Treatment. Various methods of extension having been tried during several months without avail, M. Guerin resolved on performing the section of the contracted muscle, at about eight lines or so above the sternum.
It was performed on the 2nd of December, 1837, in presence of Messrs. Lisfranc, Macloughlin, Bruni of Florence, Thompson of Edinburgh, and others.
A knife, slightly concave on its cutting edge, was passed under the fold of the integuments, which had been pinched up, and between them and the contracted muscle; and being then gently turned round, it (the muscle,) was divided without any difficulty. A distinct cracking noise was heard at the moment, and at the same time also a noisy blowing sound from the air rushing in to fill the vacuum between the divided ends of the muscle. It is well to be aware of the possibility of such a phenomenon, as a surgeon might be apprehensive of a much more serious accident-that of the introduction of air into a divided vein.
A few hours after the operation, M. Guerin, finding that there was still some resistance to the redressement of the head, and ascertaining, by the touch, that the sheath of the muscle had not been sufficiently divided, introduced a bistoury again, and made the necessary section.
The extension was not commenced till the second day after the operation. By the eleventh day the head seemed to be entierement redressée: the mechanical treatment was, however, continued for six weeks more. By this time, tous les elemens du Torticollis avaient disparus.
Case 2. M. Bray, 22 years of age, became affected with wry-neck when an infant, after an attack of convulsions. The head was inclined over to the right side, and the deformity became greater and greater, as the child grew. When admitted into La Pitié Hospital under the care of M. Lisfranc, the following was the condition of this patient.
"The head is so much inclined over to the right side, that its axis forms an angle of 135° with the axis of the body: the face is turned round to the left side, so that its anterior plane cuts that of the trunk at an angle of 45°, and a vertical line from the right commissure of the lips corresponds with the median line of the sternum: the right shoulder is higher by about two inches than the left one.
The right sterno-mastoid muscle is contracted, as hard as a piece of wood, projecting under the skin, and wholly inextensible.
The whole right side of the face is somewhat irregular and deformed."
The operation of dividing the contracted muscle was performed in the amphitheatre of La Pitié Hospital in presence of MM. Lisfranc, Piorry, Pinel, Grandchamp, and many pupils. It was quickly done by inserting the bistoury between the integuments and the muscle, and then gently turning it round, and dividing the latter. A distinct cracking noise was heard at the moment of division.
Immediately after the operation, the head could be redressée, and turned round in various directions quite freely. On the third day, the use of the mechanical permanent extension was commenced.
By the end of a month, the redressement was complete; and ultimately the free movements of the neck were completely restored.
Case 3. This case occurred in a young girl, the contraction having existed for seven or eight years. The operation of dividing the affected muscle was performed by Dupuytren in 1822. It would seem however, from the report of the case, that the deformity, although very much diminished, was not entirely removed.
Case 4, is reported by M. Stromeyer in his treatise, Ueber Paralyse der Inspirations Muskeln, 1826, and occurred in a child eight years of age. The affection was of three years' standing. M. Stromeyer, having introduced a bistoury through a fold of the integuments, and then turned it somewhat round, divided both portions, the sternal as well as the clavicular, of the muscle: a distinct cracking noise was heard at the time. The operation was crowned with
Case 5. Differed considerably from the preceding cases in several particulars. The affection of the muscle seems to have been merely spasmodic, and moreover to have been intermittent and not permanent. Various means having however been ineffectually tried to relieve the disease, M. Stromeyer determined to divide the sternal portion of the muscle. The operation was followed by very great relief for some time; but the severe sufferings of the patient having returned from a renewal of the spasmodic contractions of the muscle, the clavicular portion also was divided. For some months the patient continued free from her complaint. The spasms of the neck once more however recurred; and now it was discovered that they were seated in the clavicular portion of the trapezius muscle. A third operation was therefore performed for the purpose of cutting the contracted fibres across. From this period the disease was completely cured, and the patient was enabled frequenter le monde et le spectacle.*
Case 6. Occurred in the practice of Mr. Syme of Edinburgh, and is reported in the Edinburgh Medical and Surgical Journal for April, 1833. The disease, wry-neck, had lasted for upwards of a year, and had resisted the repeated ap. plication of blisters and the employment of various other remedies. The contracted muscle was therefore divided; and it may be sufficient to state that the cure was speedy and complete.-Gazette Medicale de Paris.
FISTULA OF THE CORPUS SPONGIOSUM URETHRÆ TREATED BY SUTURE.
The patient had been annoyed with a urinary fistula for a long time, when he was admitted by M. Ricord into the Hôpital des Veneriens, to be operated on after the method proposed by M. Dieffenbach of Berlin.
This method consists in simply passing a needle armed with a silk thread or two through the skin-not more deeply-on each side of the fistular opening, and tying the ends of the threads over a small cylinder of sparadrap or of bougie. A catheter should be first introduced into the bladder, and it should be allowed to remain there for a few days, in order to prevent the urine from pressing along the urethra, and interfering with the process of cicatrisation.
On the following day the parts surrounding the sore were swollen and tender;
Before dismissing this case, the report of which, although very brief, sufficiently explains its leading features-we cannot avoid saying that the treatment appears to us to have been unnecessarily operative. We are well aware how difficult, nay, sometimes how impossible it is to judge of the propriety of treatment in any particular case, unless we have seen and examined the patient.
To resort however to the section of muscles, which may be affected with convulsive contractions, must always be considered a very harsh resource. We particularly recommend to our readers the perusal of a very valuable paper by M. Recamier-a summary of which will be found in the number of this Review for July last-on "The Efficacy of Extension, Shampooing, and Percussion in Muscular Contractions." Rev.
and next day the ligature had given way. Although the catheter was retained constantly in the urethra, the edges of the fistula were always moist with urine. A free suppuration from the ulcerated edges was established, a tendency to granulation and to coalescence was perceived, and there was less and less oozing of the urine. M. Ricord was quite gratified with the progress of the case, and expressed his hopes that the cicatrization not only of the skin but of the spongy texture of the urethra was nearly completed.
Unfortunately a few days after this period a fresh attack of inflammation in the part came on; an abscess formed, and the fistula was re-established. M. Ricord attributed this contre-temps to the awkward attempts of the patient in trying to introduce the catheter for himself.
(The report of the case ends here).-La Lançette Française.
It must always be a difficult thing to induce the healing of urethral fistula. The spongy body of the urethra does not readily take on the adhesive inflammation, and the tendency to healing will be much counteracted by the oozing of the urine, in spite of the constant use of the catheter.
CASE OF HYDATIDIC GOITRE, OR HYDROCELE OF THE NECK, SUCCESSFULLY TREATED BY OPERATION.
Jean Peretti, 50 years of age, had perceived some years ago a small tumor on the right side of the larynx: it gradually became larger and larger, until at length it acquired a very considerable size. The compression which it made on the jugular vein had caused an attack of apoplexy; and moreover the deglutition and the speech also were frequently a good deal embarrassed.
The case having been regarded as one of goitre, had been treated with iodine, burnt sponge, &c.; but without success. The continued and rapid enlargement of the swelling at length occasioned a rupture of one of the subcutaneous veins of the neck, and this was followed by an extensive ecchymosis. At this period the patient consulted Signor Petrali. He found that the tumor occupied the entire right side of the neck from the lower jaw to the clavicle. Anteriorly it exhibited a bilobular appearance, and it felt soft and fluctuating under the finger. M. Petrali, after a minute examination, gave it as his opinion that the tumor was a hydrocele of the neck, and he therefore advised the patient to submit to an operation.
An incision was made along the vertical axis of the tumor, by which the skin, cellular substance, and platysma myoides were divided. The cyst was thus fairly exposed; its parietes were shining and tendinous-looking. The fluctuation of fluid within being quite distinct, the cyst was freely opened; a large quantity of a yellow, limpid, and inodorous fluid escaped.
The lower or depending part of the cyst was now found to form a cul-de-sac, which extended downwards under the clavicle. A sort of transverse septum or diaphragm, formed by a fold of the parietes, was observed at this part of the sac: the septum being pulsatile, Signor Petrali at first suspected that it might be the subclavian artery partially displaced; but he soon satisfied himself that this was not the case, and he therefore completed the incision of the parietes of the cyst without any interruption.
The hæmorrhage having been arrested, the cavity was filled with lint, and the edges of the wound were then approximated.
On the fourth day after the operation, while dressing the wound, the surgeon observed at its upper and anterior corner a part of another tumor, which, although not fluctuating, he considered to be of the same nature as the one which had been opened. It was in a great measure concealed by the sterno-mastoid