Address DELIVERED AT THE OBSTETRICAL SOCIETY OF LONDON, FEB. 3RD, 1869.

224 The pulse at the wrist was almost imperceptible, tuted. The practical study of obstetrics is beset with diffiand there appeared every reason to apprehend immediate culties, and owing to this and other causes the department dissolution. At this trying juncture I observed a large is one which had not in this country been cultivated to the sponge lying in the room; and as both my hands were same extent as other branches of medicine. In numerous engaged in endeavouring to control the fearful h2emor- distinguished exceptional cases the science received its rhage, I directed that the sponge should be threaded with proper share of attention, but the medical community at some strong string, and washed in cold water, when I large had not thoroughly studied it. The practice was insqueezed it into as small a compass as possible, and intro- spired too much by imperfectly understood traditions of the duced it into the uterus. Immediate contraction took place past, which were slavishly followed, and yet hesitatingly round the sponge, and after gently applying a bandage and distrustfully obeyed. Accordingly, when this Society over the abdomen, and persisting in feeding for some hours was formed, it at once received the support of the profession, with liquid food at frequent intervals, the pulse became and from all quarters we received gratifying communicagradually more perceptible, and the patient was rescued tions on the subject. For ten years the Society has now from a state of imminent danger. The sponge was ex- flourished, and during that time has more than fulfilled the pelled into the vagina upon the third day, and was re- anticipation of its founders. It has formed a centre and moved by the attached string without diffculty, and the bond of union for obstetric practitioners throughout the patient recovered more rapidly than could have been ex- country. We have become, as the " Transactions" will testify, the depository of the carefully obtained experience pected, after such a loss of blood. I have since used the same plan in several cases of of eminent observers in, it may be truly said, all parts of the uterine haemorrhage in my own practice, and when I have I world. Many of these facts and observations would probably been called in to assist other practitioners, and it has been at- havebeen unknown and uncommunicated to the profession tended with unvarying success. I believe the plan to be but for the opportunity offered by this Society. The discusvaluable (as in the case I have recorded) in some apparently sions which have taken place at our meetings have con! tributed, we cannot say how much, to the mutual improvehopeless cases. No doubt the elasticity of the sponge keeps up a constant ment of those who have taken part in them, to the dissipation regular pressure upon the whole of the internal superficies of prejudice, and to the discovery of truth. Opportunities of the uterus, whilst its spiculæ also stimulate the uterus to have been given for the ventilation and sifting of new theories. New facts have been communicated; on many contract. I have been in the habit of injecting a weak solution of occasions old facts have been presented with new and imcarbolic acid to arrest fetor, both before and after the proved faces; while we have had the satisfaction of knowsponge is removed; but if it were desired to apply any ing that the advantageous effects of these our proceedings other remedy, such as the solution of the perchloride of have not been limited to the members of this Society, but iron, &c., it could not be applied better than by injecting it have been participated in and shared by the whole profesinto the sponge. But one great advantage of this plan of sion. At home and abroad, the success of our efforts to elevate and improve the practice of obstetrics, and the kintreatment is that it can do no harm. dred subjects, those of the diseases of women and children, Sydenham, Jan. 1869. have been most fully and cordially acknowledged. Few of those who have been in the habit of frequenting our meetings will hesitate to confess their obligations to it in one form or other. Engaged in a common work, pressing forwards for the same end, it is both pleasant and profitable DELIVERED AT THE to hear the opinions of others, to experience their sympathy in our difficulties, and to receive their congratulations on OBSTETRICAL SOCIETY OF LONDON, our successes; for, however we may look to the public at FEB. 3RD, 1869. large for substantial rewards, it is very certain that no pleasure is so great or so unalloyed as that which we expeBY GRAILY HEWITT, M.D. LOND. rience in the deserved applause and appreciation of our. professional brethren. The good work of this Society will, as we all must hope, first as on this chair duty GENTLEMEN,-My taking your President is to convey to you my thanks for the distinguished continue. Ars Zonga, vita brevis est. The necessities for its work will long outlive our time, and humanity will doubthonour you have conferred in electing me to that respon- less be under still further and deeper obligations to it for sible office. I beg to assure you that I am deeply penetrated services rendered both in the saving of life and in the miti by this expression of your sentiments towards me, and I gation of suffering. I think it well now, gentlemen, to refer for a moment to thank you most sincerely. The interests of the Society have a matter which has an important bearing on obstetric from the first day of its existence been a prominent object science and on obstetric practitioners. I mean that releof my thoughts and attention, and it has been to me a source gation of obstetric practice to another, I will not say inof the deepest gratification that its success has been so com- ferior, order of practitioners, which has been advocated in plete, and its prosperity so increasing, as to be almost un- certain quarters. In the interests of our science, and not interests of the public, we cannot refrain from paralleled in the history of scientific Societies. You may less in the be assured that in this my new relation to the Society, no taking a decided position in this matter. The practice ofobstetrics requires education, high mental effort shall be wanting on my part to further its advanceand a wide range of medical knowledge, not less training, ment, and I beg you to believe that I estimate-I trust suf- than tact and judgment. Physical strength and fortitude, ficiently-the extent of the responsibilities attaching to the also, are qualities which cannot be dispensed with. In the office. My distinguished predecessors in this chair have left skilful obstetric practitioner we find a physician as well behind them examples which I shall, to the best of my ability, as a surgeon. Nature is ordinarily equal to the accomof the parturient process, but we all know how emulate, hoping that you will extend to me your kind in- plishment much care and skill are required when nature fails in her dulgence and assistance in my endeavours to conduct the operations, and how thankfully and appreciatingly the paaffairs of the Society in a fitting manner. tient welcomes the means of relief from her troubles. The We have every reason to congratulate ourselves, gentle- simplicity of the natural process has induced the belief in men, on the present condition and on the future prospects some quarters that for this department of the profession of the Society. As a school of obstetric medicine it has the midwife only is required. The fact that all goes so exercised, and will continue to exercise, a powerful influ- smoothly in the majority of instances lends support to this The teaching of the Society I cannot but regard as fallacy; but we, who know how unexpectedly difficulties ence. sometimes occur, requiring great skill in order that they one of its most important functions; and, looked at from this point of view, it cannot be doubted that its existence may be surmounted, do not trust our own wives and daughhas been most beneficial. Perhaps no department of medi- ters in any but skilful as well as practised hands. It may cine was so much in need of a cohesive medium as that for be a matter of opinion, but I cannot refrain from expressing belief that the great emergencies of obstetric-practice the cultivation of which this Society was specially insti-

pressed.

Address

my

225 be adequately met by anything short of masculine tthe femoral; the left in ten days, the right m sezen hours.intelligence. Undoubtedly the requirements of the com- This man, aged thirty-four years, a labourer, formerly a munity are greater than we can at all times and in all soldier for nearly ten years-infantry seven years, cavalry places supply, and therefore midwives must, under many three years,-nine years and three months of which time he

can never

be necessary; but it is certain that a skilful will be always sought for when a real difficulty occurs. Another phase of this question also must not be lost sight of. The employment of midwives, many of them quite unskilled and uneducated, has been productive of evils with which we are all too familiar. It is indeed a question whether it be not the duty of this Society to take steps for obtaining some legislative enactment to check the licence which exists in this particular. We have no desire to dictate to the public concerning a matter wherein, in the long run, their own judgment is pretty certain to be right; but it is assuredly our duty to let it be known in some tangible way that we do not consider it right or safe that the practice of midwifery should, under any circumstances, be

circumstances,

Indian service, from the age of nine years and nine admitted on two occasions into Lazarus ward. The first time was in January, 1867. For three months, or rather more, his attention had been drawn to the left leg-at first by suddenly feeling a sharp pain in the calf of the leg whilst walking. He had been occupied with any particularly laborious work at the time. Only one month before admission he observed a small swelling in the centre of the popliteal space ; his leg and ankle began to swell at the same time, and they have remained so, more or less, to this moment. When admitted, an aneurismal tumour was readily recognisable in the left popliteal space. Its size was much diminished when the current of blood through the femoral allowed to be undertaken by individuals without credentials artery was arrested. The sac contained very little fibrin. of any kind, often possessing not the smallest knowledge on Pulsation in the tibial arteries was normal. Pain is conthe subject. How far, and in what way, it behoves the tinuous behind the knee, extending into the calf of the leg; not increased when ascending or descending ladders Society to move in this matter I am not, at this moment, but it ishis work. His general health has been good; it prepared to say; for the subject is one requiring careful during continues so, and he looks very healthy. The action of the onsiderati o n. heart is irregular ; but Dr. Moxon reported that there was nothing abnormal either in respect of sound or impulse. Jan. 10th.—Pressure by means of a suitable tourniquet Little progress was was applied on the femoral artery. made towards cure in five days, although the pressure was OF THE PRACTICE OF well sustained and almost without intermission ; but some blood certainly passed through the sac. MEDICINE AND SURGERY During the following five days the tumour became gradually harder and smaller; and after eleven days’ use, no IN THE pulsation having been felt for twenty-four hours, the inHOSPITALS OF LONDON. strument was taken off. Thus the circulation through the aneurism was arrested by methodical pressure in ten days. Nullaautem est alia pro certo noscendi via, nisi quamplurimas et morborum Three days afterwards the tumour was hard, about two et dissectionum historias, tum alioruni, tum proprias collectas habere, et inches in diameter, and not in the slightest degree painful. De Sed. et Cau8. 3fof&., lib. iv. Procemium. In three weeks’ time he left the inter se ccunparare.—Mox&AaNi hospital. Before quitting the ward the patient called Mr. Birkett’s attention to the right popliteal artery, which, he thought, GUY’S HOSPITAL. beat harder" than usual. After careful examination, howA CASE OF DOUBLE POPLITEAL ANEURISM. ever, it appeared to be only slightly dilated. A tourniquet (Under the care of Mr. BIRKETT.) was applied on the right femoral for three days, and as the THE patient whose interesting case we are about to de- dilatation subsided he left the hospital. On August 3rd, 18G8, he again applied to be admitted. scribe was the subject of aneurism of the left and right This was eighteen months after the cure of the left aneupopliteal arteries. On both sides the disease was cured by rism. There was now a large aneurismal tumour in the mechanical pressure. As the case offers many remarkable right popliteal region. He stated that soon after leaving features worthy the attention of the surgical pathologist, the hospital in February, 1867, he again felt the swelling there, but that he had ever since pursued his ordinary we shall enter upon its details at some length. The tumour was very large ; the sac was but in the first place, the age of the patient is noteworthy. occupations. emptied partially by pressure on the femoral; and there a in the of he manhood, Comparatively young man, prime had doubtless led an active life in the pursuance of his was more fibrine in this one than in the first. He reposed in bed until August 6th, when at 1 P.M. the military duties, during which time he may have laid the Henry G. Turner, applied two tourniquets, one foundation of the disease for the cure of which he came a little below Poupart’s ligament, and the other about the under treatment; but the man appeared in every other remiddle of the thigh, both on the femoral artery, the circuspect extremely healthy. the The first aneurismal tumour was of recent formation, and lation through which vessel was completely arrested by of one or the other. Alternate pressure was compression seemed to consist almost entirely of fluid blood; that is to kept up with these for about half an hour at a time by say, the fibrinous deposit lining the sac was in very small Mr. Turner, who remained at the bedside of the patient quantity. The swelling had been observed one month only. until after 7 P.M. At 8 P.M. the pulsation of the tumour Under these local conditions, it required mechanical preshad ceased, but gentle pressure was continued throughout sure to be continued ten days before the circulation through the night. The next morning there was no perceptible the sac was arrested. Thus the aneurism was effectually cured by the It is a striking fact, that the right popliteal artery should pulsation. above-described treatment in seven hours. have taken on morbid action during the period of repose A hard, solid tumour, from two to three inches in diaenjoined for the treatment of the left aneurism. The dilated meter, partly filled up the popliteal space. It gradually state of the vessel which alone existed was, however, conand the man left the hospital well, having been trolled by treatment, although, as soon as the man gave decreased, time under treatment twenty-one days. this of the vessel wereunable to resist way to exertion, the coats Although eighteen months had elapsed since the cure of the pressure of the blood-current. For eighteen months he the left aneurism, pulsation was not perceptible in either of this disease. treatment those the During neglected the dorsal or posterior tibial arteries of the foot; neither months the ordinary changes in the contents of the sac ocwas there any trace of the old sac. curred, much fibrin became deposited, and a thick-walled sac existed at the second admission into the hospital, the KING’S COLLEGE HOSPITAL. very reverse of that observed on the left side. Under such local conditions, with carefully employed meTHREE CASES OF TUMOUR. chanical pressure, assiduously superintended by the dresser, (Under the care of Sir WM. FERGUSSON.) Mr. H. G. Turner, the disease was cured in seven hours. In this instance the current of blood was completely arrested. ON Saturday last we saw Sir William operate in three of tumour, each of which deserves a word of notice. Anettrism of both popliteal arteries cured by compression of

medical

man

passed in months,

was

A Mirror

dresser, Mr.

!cases