Imatges de pÓgina

tense, globular body, of the bulk of the child's head; and conveying the impression of an entire uterus, without orifice.

Abont the spot where the os uteri should have been, was a minute portion, somewhat thinner than the surrounding parts; but the whole was uniformly smooth, and contained no break whatever.

On the receding of the mass, in the absence of the pain, something like a child's head could be felt within.

Inquiries were now made, and the following facts elicited :

Mrs. P—was married on the 4th of February preceding, 1836. Since the age of 14 she had menstruated every four weeks, sometimes every three weeks. The discharge was always pale and scanty, and continued from two to three days. She never suffered pain at those periods. She has not menstruated since her marriage.

Both before and subsequent to her marriage she has had robust health ; and, in the neeessary duties of her vocation, has undergone an unusual degree of laborious exertion; but she has not had a day's ill health. For two or three days before labour came on, she noticed a rather copious reddish discharge, that continually drained from her ; but there was no pain. On the subsidence of this, about the 12th, slight pains in the back were felt, which went on till the night of the 14th, when they assumed the severe and urgent character which occasioned her to summon her medical attendant at the time already stated.

Having satisfied myself, at this second examination, that there really was no orifice into the uterus, and the pains continuing of a severe character-and the existence of a living child being proved by the pulsations of the fætal heart, which were distinctly audible, about twice as fast as the mother's pulse-I sought the advice of Dr. Ashwell.

The Doctor lost little time in arriving: and having, by a most careful investi' gation, positively confirmed the statement of the condition of parts already made, he determined upon losing no more time in making an artificial opening across the abovenamed spot, where the globular body seemed slightly thinner than elsewhere. The patient's pulse was about 120 to 130, very irritable; the pains violent; the skin irregularly hot and cold; the features anxious; the mind irritable; general restlessness: the bowels had now been twice relieved by castor oil. Accordingly, having placed her on her left side, the Doctor introduced his left forefinger as a director; upon which he passed up a curved, sharp-pointed bistoury with his righr hand; and having punctured the spot already fixed upon, he incised forwards towards the bladder (which was empty), and backwards towards the rectum. At this last incision a few drachms of dark blood flowed out. The liquor amnii of course escaped; and the head fell upon the artificial opening, which proved to be of the diameter of an inch and a half, or perhaps nearly two inches, and about a line in thickness.

The Doctor did not incise laterally, lest he should wound any of the branches of the uterine arteries. At one o'clook, A. M. of the 16th, he left the patient in charge of Mr. Roe and myself. The pains abated for a brief space after the operation, the performance of which occasioned no suffering; so that she seemed not to be conscious of any thing beyond the inconvenience of manual interference. Pains, however, recurred; but little advance at dilatation appeared to be made for some time, till about four, A. M., when under the influence of a severe pain, the edge of the orifice tore suddenly towards the right side; and soon after, another rent took place, whilst my finger was at the part, backwards, towards the left sacro-iliac synchondrosis. At this she became faint; the pulse was 140 or 150, feeble; the skin cold and clammy; and she fell exhausted. Æther, ammonia, brandy, and opium, were administered, and she rallied. After resting for about two hours, pains recurred gradually, and became as powerful as at any previous time.

The extent of the laceration on the right side could be reached by the finger; it had not extended to the reflection of the vagina: that on the posterior pas was beyond reach. No gush of blood attended these lacerations. The head became engaged in the pelvis, and was delivered at 11 A. M.

The latter pains were very inefficient; and much stimulant was administered towards the close. With the child there was a more than usual degree of hæmorrhage; the infant (a male) was asphyxiated, and was with difficulty revived.

The placenta was taken away in half an hour, and the uterus contracted well. Nothing further could now be detected on examination, but several ragged shreds about the orifice at the top of the vagina.

The tongue was dry, and brown at tip; the head ached; the pulse was 110, jerking (doubtless referrible, in some degree, to the stimulants). Towards the close of the labour, the bowels had afforded three copious motions.

Liq. Opii sedativ. mxl. statim. And, to meet the expected re-action, Haust. Efferves. c. V. Ant. Tart. et Tinct. Hyoscyami aa. Jss. Barley

water.--Quiet. [She was treated by means of opiates and effervescing draughts till the 20th, when milk appeared abundantly in both breasts. The medicines were then omitted, and the breast-pump used.

Dec. 4th.-Had a little quina, being still weak. From this time she progressively recovered. An examination was ade, of which the following is an account:-)

The vagina is short; its extremity, and every part of it, can be readily reached by the shortest fore-finger; it presents no other peculiarity.

There is no cervix uteri. The uterns seems reduced nearly to a normal unimpregnated size. At the extremity of the vagina there is a puckered irregular orifice, into which the tip of the finger can enter: it is soft, with smooth and thick edges, not perfectly circular, in consequence of certain indentations, as if from the drawing together of several small rents.

It might be compared to the base of an apple; whilst this part of a normal uterus would better resemble the apex of a pear.

Radiating froin this central aperture can be distinctly felt three ridges, like lines of adhesion; one passing forwards, towards the right ilio-pubic junction, traceable nearly to the reflexion of the vagina; one opposite to this, backwards, towards the left sacro-iliac synchondrosis, whose extremity is lost in the reflexion of the vagina; and the third, of short extent, about one-third of an inch long, passing backwards and to the right. These were distinctly ascertained, by both Mr. Gaselee and myself, to centre in, or radiate from, the aperture above named.

REMARKS.—This case is so singular, and is so accurately detailed, that it is scarcely necessary to make more than a single observation. I am not aware that a precisely similar instance is any where recorded; nor do I think that there can be any hesitation about the treatment proper to be employed. The safety of the incision consists in its prevention of limited and extensive laceration. So long as the division by the knife, and the subsequent tearing of parts, is confined to the os and cervix, and does not extend beyond the reflexion of the mucous surface of the vagina over these parts, recovery is highly probable: whereas, if the parts be left to rupture of themselves, the body and fundus of the uterus, and their peritoneal investment, are pretty sure to be implicated, and the result will most probably be fatal.--- London Medical Gazette.

MEDICAL JOURNALS. We have received the forty-first Number of the Western Journal of the MEDICAL AND Physical Sciences, for April, May, and June, 1837, being the first published under the new editorial superintendence of the Medical Faculty of the Cincinnati College. It contains Reports of Cases treated in the Cincinnati Hospital, by the home surgeons Drs. Barbee and Kimball; a Clinical Introductory by Dr. Harrison; an Essay on the Morbid Anatomy of the Liver by Dr. Gross; and Reviews and Bibliographical Notices. Under a common head of Miscellaneous, we have a number of articles arranged under three sub-heads of

lectic, Analytical, and Original.

There is one article, the sixth under the last sub-head, which is entitled to the epithet of extraordinary, still more than that of original. We do not remember 10 have ever seen the pages of a medical journal on this side of the Atlantic, disfigured by such harshness of invective, or, rather, virulence of abuse, directed against any individual, especially one who has maintained, and still retains, a respectable station as teacher and practitioner, and who aims at eminence in both capacities.

Among the advantages, and we believe it to be the chief one, from a plurality of editors or conductors of a literary work, should be the suppression or modification of the langnage of individual passion, pique, or prejudice. But if such be allowed, it becomes injurious in proportion to the additional sanction which it has received from the colleagues of the writer, and who must at the same time be charged with their share of whatever odium attaches to the obnoxious production. We should say, then, in a spirit of kindness to the Medical Faculty of Cincinnati College, and of esteem for the vigorous intellect and fearlessness of the author of the article in question, that it is far from being creditable to them, either in their editorial or professional capacity.

SOUTHERN MedicAL AND SURGICAL JOURNAL, Vol. II. No. 1. August 1837. We are pleased to see that this work is, after a short suspension, resumed, with a display of its customary merits, under the editorial directon of Dr. Milton Antony, one of the Professors in the Georgia Medical College. The number before us is in a new dress-of a superior quality both as regards paper and type. It contains, among several original articles, two which possess much interest to the physiologist, the one a “Report of a Case of Extra-uterine Fætation in a Sow; with some remarks on the Nutrition of the Fætus, by Addison Bean, M.D., of McDonough, Ga.; the other, “An Account of an Anencephalous, or Human Monstrosity, without Brain and Spinal Marrow." By Alexander Y. Nicoll, M.D., and Richard D. Arnold, M.D., of Savannah :" with three illus. trative engravings. We are glad to find our former pupil and friend, Dr. Arnold, intent on adding to the stores of physiological history. On another occasion the observations which he has recorded will be noticed in our “ Eclectic."“ Verminous Irritation, assimulating other diseases,' “ The Diuretic Virtues of the Root of the Azalea, or Honeysuckle," and an Essay on Female Diseases,” are the subjects of Articles by Drs. Lee, Macon, and Meek. The advantages of an “ American Medical Association,” are argued in another division of the Southern Journal. “ Thomsonian Surgery” is shown up in its appropriate guise. Reviews and extracts, and Notices of Medical Colleges make up the rest of the Number.

Transactions of the Medical Society of the State of New York.

Vol. III., Parts 1 and 2. 1836–7. Albany. E. W. & C. Skinner.

The papers composing these Transactions, the First Part of which we have recently received from the publishers, although, as might naturally be expected, of unequal merit, are, taken collectively, creditable to the Society from which, and under whose auspices, they emanate. The initial article in each Part is the Annual Address by the President of the year ;-that for 1836, by John H. Sleel, M.D.; and the one for 1837, by James McNaughton, M.D. The former is “On the Derangement of the Digestive Organs;" the latter, “On the Progress of Medicine in this State" (New York).

Dr. Steel's Discourse exhibits the subject in a clear and distinct point of view, without, at the same time, any pretensions to novelty. The evils of excessive repletion, and endless variety of aliment, having been stated, the author dwells somewhat on the pathology of the derangement in question, and expresses his dissent from the dogma that there may be serious functional disturbance without organic change. He protests with animation against the opinion of debility, alone, being the cause, rather than a symptom of indigestion and its consequences, and he deprecates the hasty and too common resource to tonics and stimulants. He says, correctly :

Physiological researches have demonstrated that the irritability or morbid excitement which constitute the derangement of the organs of digestion, may be situated in various parts of the alimentary canal; as the æsophagus, stomach, small intestines, colon or rectum, and that it is often confined to some one of the structures which compose these organs, as the peritoneal, the muscular or the mucous membranes. It is of importance to ascertain the location of the disease and the particular structure of the organ affected, for these are circumstances which are found greatly to modify the character and symptoms of the disease, and serve to influence our judgment as to the result of its termination. In almost all cases, particularly those of recent occurrence, the disease is confined to one particular organ, and frequently to a small surface of that organ, or a portion of some one of its membranes. The excision of an elongated uvula, which had continued for months and produced a considerable degree of irritation about the throat, effected the immediate cure of an obstinate case of indigestion, which evidently had its origin with that of the irritated fauces; and the removal of hemorrhoidal excrescences has, in some instances, produced the same effect, in cases equally obstinate.

Polypharmacy, and the fluctuating plans of treatment in derangements of the digestive organs are commented on with suitable emphasis by Doctor Steel, whose situation as physician at Saratoga enables him to see annually a large number of persons suffering from these disorders, and to learn the medicinal course to which they had been subjected. He sums up his views in the following propositions :

" That the powers of the digestive organs of man, when in a regular and perfect condition, are capable of reducing the most dissimilar and differently constituted materials of food, into a healthy and homogeneous mass, suitable for the circulation and qualified to supply the wants and increase the growth, vigor and strength of the system.

That this property of the organs is the result of structure, and cannot be changed, altered or modified in any way, but by an alteration or derangement in the structure itself.

“ That slight derangements of some of these organs, or their tissues, frequently occur, as in the case usually termed Dyspepsia, for which abstinence and rest constitute a certain and speedy remedy.

" That functional derangement is but the symptom of organic disease, on which it is entirely dependant.

** That these derangements, however slight, are the result, in all cases, of morbidly increased irritability or excitement of the organ or tissue affected, modified and characterised by the peculiarities of structure, and when neglected á or improperly treated, advance into acute infiammation, or are converted into chronic ailections, and terminate in engorgement, congestion, effusion or ulceration.

" That in the treatment of the derangement of the digestive organs, stimula

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ting and tonic medicines are absolutely inadmissible, and in all cases, can have no effect, other than to procrastinate the disease or render it incurable.

" That the pathology of organic derangement, the causes which operate to produce it, and the actual state of the organs so far as that can be ascertained, all indicate the propriety of the antiphlogistic treatment, regulated by a sound judgment and a perfect knowledge of the organs or tissues affected.

“It will readily be perceived, by those who have examined the subject or have made themselves at all familiar with the writings of modern authors, that in the foregoing observations there is no attempt at novelty or the promulgation of new or speculative opinions; the subject has been thoroughly investigated by individuals whose names alone are sufficient to furnish for their opinions a passport to the mind of the most sceptical, and whose genius and acquirements elevate ihem far above the common rank of their cotemporaries.”

Doctor McNaughton's Address contains a History of the Progress of Medicine in New York, as connected with the Foundation and Endowment of Schools and Societies for its cultivation and teaching.

“ The first general law regulating the Practice of Physic and Surgery, was passed in 1797. By the act of 23 March of that year, every student was required to study four years, if not a graduate, and three, if a graduate. It was also enacted, that any person practising without a licence, should pay a fine of twenty-five dollars. "It was further provided, that in case of some sudden emergency, any person might administer medicine, or even perform surgical operations ; but no demand for compensation, for the services rendered, could be lawfully made. This act continued, without material alteration, until April 4th, 1806, when the law incorporating the State and County Medical Societies was passed.”

Although prior to the passage of the Act of Incorporation of the State and County Societies, in which it was declared, among other things, that no person should practice physic or surgery in the state without first having received a license as doctor, there existed some medical societies in New York, and other places, their influence was limited as well as their privileges. It was not until the organization of the State and County Societies took place, says Doctor McNaughton, that the profession acquired a regular form.

In three months after the passage of the law, no fewer than twenty County Medical Societies were formed, pursuant to its provisions; and in two years there was scarcely a county in the state of any considerable population without its Medical Society.

“The first meeting of the State Medical Society took place on the third day of February, 1807. Dr. W. M'Clelland, of this city, was chosen President, and Dr. Sheldon, of Montgomery, Vice-President. The Society adopted sundry resolutions for the promotion of Medical Science. Each member of the Society was directed to furnish a Geological and Topographical Survey of the County of his residence, and to read before the Society an account of any remarkable case of disease that might have occurred in his practice.”

Notwithstanding these apparently liberal measures for the elevation of the profession and the extension of its usefulness, Dr. McNaughton makes the following complaint against legislative blindness :

“ It remained, however, for the state of New York to legalize quackery, by positive enactments. The general provisions of the law of 1806 were retained in the revision of 1813, with this most extraordinary proviso:—That nothing in this act contained shall be construed to extend to debar any person from using, or applying, for the benefit of any sick person, any roots, barks, or herbs, the growth and produce of the United States.'»

Still no provision had been, hitherto, made for founding medical lectureships,

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