- Email: [email protected]
ALUMINIUM SUTURES,
Yeovil that day. We met in consultation about half-past eleven A. M. The os uteri was then considerably dilated, and a portion of the placenta was ascertained to be detached towards the sacrum. This accounted for the preceding hasmorof sensations and depression could be produced by ipeca- rhagic discharges ; and as the patient was considerably blanched cuanha, even if its effect could be carried on, and the medicine and anxious to be delivered, the pains also getting weaker, we determined to deliver her. I introduced my left hand along were not rejected by the stomach, which is- invariably the I have the curvature of the sacrum, ruptured the membranes, and case when the effect is increased to a certain point. not gone beyond the stage of perspiration and a feeling of sick- brought down the feet and pelvis of the child. Spasmodic ness, and I have always found the cure to resemble the natural action of the uterus then set in, encircling the body of the process of mucous discharge and clearing of the air-passages, child so firmly as to render -it difficult, if not dangerous, to only more promptly induced and more rapidly performed. I proceed. I administered chloroform to the patient, while Mr. have frequently had short spasms of asthma produced by Mooreattended’ -to- the further expulsion of the child. The laughing, lighting a lucifer-match, or some other special irritant, difficulty was somewhat increased by the face being turned from which I have recovered as rapidly as when under the towards the pubis; however, by some manipulation, the arms influence of ipecacuanha, going through the stages of silent were got down and the face brought in the proper position,. asthma, audible asthma, and the expectoration mentioned- when delivery speedily followed. We had the satisfaction to find the child alive; it cried above, in about the space of ten minutes or a quarter of an hour. The distinction between these two modes of cure or relief is once, but almost immediately ceased apparently to live. The Worthy the attention of medical men and their patients, as cord was tied. Without delay we had recourse to the Ready,much distress and perhaps injurious results might be avoided Method, and after persevering in it for more than fifteen:. if the ipecacuanha is found to be as efficacious as tobacco. My minutes we were gratified to find it had succeeded. The child. only doubt is whether tobacco might not’ be preferable in gradually lost its livid hue, breathed and cried, and soon at= desperate and suffocating spasms on account of its speedy and tained a natural rosy colour. One feature in the case must not be omitted., The mother violent action." No doubt there is such a difference as that indicated above did not rally so soon as could be wished, and it was found in the action of tobacco and ipecacuan. Ipecacuan, I think, necessary to watch her for some time, administering cordials’ could ’never produce such collapse as that caused by tobacco; and nutriment; but she nevertheless became more and more but that it does not always act as an expectorant or emetic, exhausted. As there was no haemorrhage observed externally, but as a direct depressant, is shown by the case that ’I related suspicion arose that there might be internal hæmorrhage. This just now: The fact is, ipecacuan acts very differently on dif- was ascertained to be the case; and the hand being introduced, ferent’ individuals : in some, producing vomiting with little a considerable quantity of coagula was removed, when’ the The more irritation than sulphate of zinc; in some, producing col- uterus contracted and all further haemorrhage ceased. and mother child are now both- doing well. the, to a considerable Moreover, by relaxing lapse’ degree. bronchial spasm, ipecacuan renders free cough and expectoraAngust,.1858. tion possible, which were previously impossible, from inability to get sufficient air into the lungs to effect them so that the ON A CASE expectoration is the consequence of the relief, and not the OF relief of the expectoration. OF THE DEFICIENCY OF (To be continued.) me to be strongly marked and very important. I conceive this to arise from the intensity of the depression caused by the poison of tobacco, which cannot be the case in the use of ipecacuanha, as it is a simple emetic, and I doubt if the same
to
kind
DEVELOPMENT
SUPERIOR, POSTERIOR,
ASPECT OF THE FŒTUS.
REPORT OF A
CASE OF PLACENTA
PRÆVIA,
IN WHICH TURNING WAS SUCCESSFULLY RESORTED TO, CHLOROFORM GIVEN WITH ADVANTAGE, AND THE CHILD RESUSCITATED BY THE ’’READY METHOD."
BY E. C.
AND ANTERIOR
GARLAND, M.R.C.S., &c.,
Yeovil,
LATE SENIOR HOUSE-SURGEON TO THE SOUTHERN HOSPITAL, LIVERPOOL.
BY J. S.
BEALE, ESQ., M.R.C.S.
MRS. W-,primipara, was delivered of amale child (seven months and a half), which presented the following appearances,: -It, had no neck, the head being stuck atop ofthe chest. The occipital bone was flattened’down on to the sea." pulea. The brain was outside the skull, and contained in- a thick membranous cyst, which cyst had several coagula,-inside as well. The laminae of the vertebrae were wanting down tw the upper part of the lumbar region, a thin shell of bone being_ thrown across to protect the spinal marrow; there was no bulging of the contents of the spinal canal. A large transparent serous-looking cyst occupied the abdominal region, through. which the liver and intestines could be distinctly seen ; the cyst contained a largish quantity of fluid ; the umbilical cordwas inserted at the lower part of the right side of it, and not centrally. The arms and face were softened through decomposition commencing. Nothiag could be elicited from the patient tending to fix any, cause (through fright or otherwise) to elucidate the malforma-
It WAS’ sent’ for on the evening of June 18th, 1858, to see A. B-, aged twenty-nine, taken suddenly ill with flooding. found her about eight months gone with her eighth child, her previous labours having been good. She stated that she had exerted herself much of late, but had continued well till the present time. She had no pains, but a constant oozing of blood. On examination, I found the os uteri thick and not dilated. There were no symptoms of labour. I ordered her to be kept in the recumbent position and perfectly quiet, the room cool, gave an opiate, and left, intending to call again shortly. I saw her at the end of an hour: all hæmorrhage had ceased, and she felt comfortable. I left directions to be sum- tion. Paddington-green, September, 1858. moned immediately should the haemorrhage recur. On seeing the patient the following morning I found there had been’no return of the hæmorrhage, and she had passed a ALUMINIUM SUTURES, good night. I desired her to remain in the recumbent position, and endeavoured to impress upon her the necessity of attending A CHEAP SUBSTITUTE FOR THE SILVER. to my directions. She continued free from haemorrhage during a fortnight, at the end of which period I was again called to BY J. MILL FRODSHAM, M.D., see her. I found affairs nearly in the same state as before, and HOUSE-SURGEON TO THE CUMBERLAND INFIRMARY. with same the like result. the treatment, adopted On July 13tb, between eight and nine A.M., I was again summoned. Labour had now commenced. There was consiFEW surgeons who have tried the silver suture will, I think; derable hæmorrhage; the os uteri was dilated to the size of a the great advantages it possesses over the thread or silk deny half-crown piece; and I found the placenta presenting. As the pains increased I waited a little, resolving to act when in common use, especially where union by the first intention- iss necessary. I sent for assistance, and succeeded in procuring required. The only drawback to its general use appears to be, the aid of 3.1r. Moore- of BVest tinker- whn chanced -t-n to be in its great-cost. As a cheap substitute for this; I would’recom-
280
metal recently discovered in Paris, for sutures as silver-viz., pliability, not causing any irritation, or becoming discoloured; and having this advantage, it being half the price. In the cases in which I have tried it, I applied the silver and aluminium alternately, and allowed them to remain in the wound nine days; when examined at the end of that time, no perceptible difference could be detected in them.
mend aluminium, the
possessing
- September,
the
same
new
qualities
1858.
A Mirror OF THE PRACTICE OF
MEDICINE AND SURGERY IN THE
On her appearance at the hospital on the 12th of July, she stated that she had, on the Saturday previous, after a great deal of pain and some haemorrhage, passed a calculus, which she brought to the hospital for inspection. It proved to be a;. specimen of the oxalate of lime or mulberry calculus, was about the size of a large pea, and was very rough and nodulated. The patient was of course very much relieved, but she still continues under treatment. The urine was examined on her second visit, and found to haveaslightly acid reaction; specific gravity 1 ’017. Under the microscope no crystals of oxalate of lime or lithic acid were visible. She has since stated that about four months ago she passed a calculus about the size of the head of a large pin, and which, from her description, appears to have been of a similar kind to that recently passed.
HOSPITAL FOR CONSUMPTION AND DISEASES OF THE CHEST, BROMPTON. PECULIAR CARDIAC SOUNDS.
HOSPITALS OF LONDON.
(Under the
care
of Dr. EDWARD
SMITH.)
THREE patients were recently under Dr. Smith’s care, in whom he has ascertained the existence of a sound in the chest which is rare and deserving of notice. It is situate only in the second and third intercostal spaces of the left side, on front UNIVERSITY COLLEGE HOSPITAL. and midway between mid-sternum and coracoid process, and is RENAL CALCULUS FOR FOUR OR FIVE YEARS, WITH THE restricted to a space which may be covered by the stethoscope. PASSAGE OF SMALL STONES COMPOSED OF OXALATE The following is a short description of each case, with notes of OF LIME. the character of the sound made at each visit. M. N-, a female, aged twenty-one; single; a servant;.; (Under the care of Dr. HARE.) She has has tubercle of both lungs in a state of HÆMATURIA, or bloody urine, is oftentimes a symptom of been ill but two months, and then had giddiness and a little followed by a little cough, but no dyspnœa. Qr the presence of calculi in the kidney, but as this condition of the urine may proceed from a variety of causes, without some palpitation of the heart. Soon afterwards, and not before, she other concomitant symptoms, the physician would not under- lost flesh and strength, and had swelling of the feet. She had also on the level of the left nipple, which passed up to the take to diagnose the presence of renal calculus. When, there- left shoulder. She is now thin, very excitable, and has nushed fore, we meet with severe pain in one or both loins, with cheeks, with much debility and dyspnœa on exertion. There hæmaturia, occasional fits of inflammation of the kidney, and a is but little cough or spitting. The appetite and digestion are clear enlargement of the organ, as was present in the following good. Tongue clean and bowels regular. The pulse is 136, and respiration 34 per minute; and the vital capacity is only case, we may feel pretty sure there is a stone. In the male sex, cubic inches. fier height is 5 ft. 0 in. On the right side, in addition to these signs, there is not unfrequently irritation 50 there IS great dulness on percussion universally, YYSLli Vury and retraction of the testicles. The correctness of the diagnosis feeble and short efforts and a cavity. On the left inspiratory was verified by the passage of a small calculus, which proved side, the dulness is chiefly below the third rib, with harsh to be oxalate of lime. This form is rare from the kidney, but respiration and indistinct signs of a cavity at the third intercostal space, stretching across the chest in the left side. At a very remarkable case of the kind is given by Dr. Watson in his work " On the Practice of Physic," in which a small this place, there is a short, sharp thrill with each pulsation of the heart, and there are three between the inspirations. It is mulberry calculus, studded with crystals was voided, the not heard during inspiration, because the inspiratory-sound has general symptoms partaking more of those of ordinary colic. a similar tone and quality, and is louder, but it is heard immeThe oxalate of lime calculus is generally known by its nodu- diately the inspiration has ended, and with the expiration, and lated shape and resemblance to a mulberry, but as these are in the interval between the inspirations. It is heard when the not seen in small specimens, its true nature may readily be breath is held in expiration, but it is then of a softer quality, and seems a little more distant. It is not heard when the determined by heating a crystal or piece of it on platinum foil breath is held in inspiration. There is a double sound at-the by means of a spirit-lamp and blow-pipe. The oxalic acid base of the heart, but at the apex the sounds are normal Both becomes converted into carbonic acid, which is driven off by pulses are synchronous with the sound under discussion, and and regular. There is no thrill when the hand is strong heat, and lime remains, easily known by its turning are distinct over the heart or the lungs, and no peculiar movement placed brown when powdered on turmeric paper. in the arteries or veins, but the action of the heart feels We are indebted to Mr. F. B. White for the notes of the fol- tumultuous. She never had pain at this spot, nor any sign lowing case :but palpitation, and that during a fortnight only. In a fortnight the sound was still audible at the same place, E. C-. a female aged thirty-four, rather stout, of florid complexion and healthy appearance, was admitted as out- but somewhat less extensive. The respiratory sounds are still patient on July 8th, 1858, suffering great pain in the region of harsh, short, and wavy. She is no worse. In ten days furtherthe right kidney, which pain had existed more or less severely the sound is still distinctly heard, but it is not heard when she since the Sunday previous. She stated that she had had at whispers. times uneasy sensations in the right lumbar region for four or Dr. Smith was of opinion that this sound was a modified five years past, but that they had not troubled her much till heart sound, and the sound of the heart could be distinctly about five months ago, when the pain became very severe, and heard at the same time in another tone. The quality of the she passed some and had continued to do so at intervals tone of the sound referred to is much thr.t of a rough bronchial up to the time of her admission. She has also noticed that the respiration. urine has been loaded with gravel on several occasions during C. H-, a shipwright, aged twenty-five, single, has tuthe past three or four years. On manipulation in the region of bercle with a cavity in the right lung, and probably deposited. the kidneys, the right one was found to be somewhat enlarged, the left. His vital capacity is 152 cubic inches. and decidedly tender on pressure; the left appeared natural, On April 30th the heart was healthy. On May 1 dth he comand there was no tenderness. Dr. Hare diagnosed the case a6 plained of pains in the left side with palpitation ; but, except one of renal calculus, and the patient was a foul state of the tongue, he progressed very favourably upon a mixture containing spirit of nitric ether, bicarbonate of potash, .anc through the whole year. On December 24th, Dr. Smit disthe sound referred to in the third space, and-then tincture of.henba.ne, and directed touse warm hip-baths.
- Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum et disseetionum historias, tam aliorum proprias, collectas habere et inter se comparare.-MORGAGNI. De Sed. et Cuus. Morb, lib. 14. Procemium.
softening.
haemoptysis,
pain
blood,
tubercle in
put
for
covered
281
to
kind
DEVELOPMENT
SUPERIOR, POSTERIOR,
ASPECT OF THE FŒTUS.
REPORT OF A
CASE OF PLACENTA
PRÆVIA,
IN WHICH TURNING WAS SUCCESSFULLY RESORTED TO, CHLOROFORM GIVEN WITH ADVANTAGE, AND THE CHILD RESUSCITATED BY THE ’’READY METHOD."
BY E. C.
AND ANTERIOR
GARLAND, M.R.C.S., &c.,
Yeovil,
LATE SENIOR HOUSE-SURGEON TO THE SOUTHERN HOSPITAL, LIVERPOOL.
BY J. S.
BEALE, ESQ., M.R.C.S.
MRS. W-,primipara, was delivered of amale child (seven months and a half), which presented the following appearances,: -It, had no neck, the head being stuck atop ofthe chest. The occipital bone was flattened’down on to the sea." pulea. The brain was outside the skull, and contained in- a thick membranous cyst, which cyst had several coagula,-inside as well. The laminae of the vertebrae were wanting down tw the upper part of the lumbar region, a thin shell of bone being_ thrown across to protect the spinal marrow; there was no bulging of the contents of the spinal canal. A large transparent serous-looking cyst occupied the abdominal region, through. which the liver and intestines could be distinctly seen ; the cyst contained a largish quantity of fluid ; the umbilical cordwas inserted at the lower part of the right side of it, and not centrally. The arms and face were softened through decomposition commencing. Nothiag could be elicited from the patient tending to fix any, cause (through fright or otherwise) to elucidate the malforma-
It WAS’ sent’ for on the evening of June 18th, 1858, to see A. B-, aged twenty-nine, taken suddenly ill with flooding. found her about eight months gone with her eighth child, her previous labours having been good. She stated that she had exerted herself much of late, but had continued well till the present time. She had no pains, but a constant oozing of blood. On examination, I found the os uteri thick and not dilated. There were no symptoms of labour. I ordered her to be kept in the recumbent position and perfectly quiet, the room cool, gave an opiate, and left, intending to call again shortly. I saw her at the end of an hour: all hæmorrhage had ceased, and she felt comfortable. I left directions to be sum- tion. Paddington-green, September, 1858. moned immediately should the haemorrhage recur. On seeing the patient the following morning I found there had been’no return of the hæmorrhage, and she had passed a ALUMINIUM SUTURES, good night. I desired her to remain in the recumbent position, and endeavoured to impress upon her the necessity of attending A CHEAP SUBSTITUTE FOR THE SILVER. to my directions. She continued free from haemorrhage during a fortnight, at the end of which period I was again called to BY J. MILL FRODSHAM, M.D., see her. I found affairs nearly in the same state as before, and HOUSE-SURGEON TO THE CUMBERLAND INFIRMARY. with same the like result. the treatment, adopted On July 13tb, between eight and nine A.M., I was again summoned. Labour had now commenced. There was consiFEW surgeons who have tried the silver suture will, I think; derable hæmorrhage; the os uteri was dilated to the size of a the great advantages it possesses over the thread or silk deny half-crown piece; and I found the placenta presenting. As the pains increased I waited a little, resolving to act when in common use, especially where union by the first intention- iss necessary. I sent for assistance, and succeeded in procuring required. The only drawback to its general use appears to be, the aid of 3.1r. Moore- of BVest tinker- whn chanced -t-n to be in its great-cost. As a cheap substitute for this; I would’recom-
280
metal recently discovered in Paris, for sutures as silver-viz., pliability, not causing any irritation, or becoming discoloured; and having this advantage, it being half the price. In the cases in which I have tried it, I applied the silver and aluminium alternately, and allowed them to remain in the wound nine days; when examined at the end of that time, no perceptible difference could be detected in them.
mend aluminium, the
possessing
- September,
the
same
new
qualities
1858.
A Mirror OF THE PRACTICE OF
MEDICINE AND SURGERY IN THE
On her appearance at the hospital on the 12th of July, she stated that she had, on the Saturday previous, after a great deal of pain and some haemorrhage, passed a calculus, which she brought to the hospital for inspection. It proved to be a;. specimen of the oxalate of lime or mulberry calculus, was about the size of a large pea, and was very rough and nodulated. The patient was of course very much relieved, but she still continues under treatment. The urine was examined on her second visit, and found to haveaslightly acid reaction; specific gravity 1 ’017. Under the microscope no crystals of oxalate of lime or lithic acid were visible. She has since stated that about four months ago she passed a calculus about the size of the head of a large pin, and which, from her description, appears to have been of a similar kind to that recently passed.
HOSPITAL FOR CONSUMPTION AND DISEASES OF THE CHEST, BROMPTON. PECULIAR CARDIAC SOUNDS.
HOSPITALS OF LONDON.
(Under the
care
of Dr. EDWARD
SMITH.)
THREE patients were recently under Dr. Smith’s care, in whom he has ascertained the existence of a sound in the chest which is rare and deserving of notice. It is situate only in the second and third intercostal spaces of the left side, on front UNIVERSITY COLLEGE HOSPITAL. and midway between mid-sternum and coracoid process, and is RENAL CALCULUS FOR FOUR OR FIVE YEARS, WITH THE restricted to a space which may be covered by the stethoscope. PASSAGE OF SMALL STONES COMPOSED OF OXALATE The following is a short description of each case, with notes of OF LIME. the character of the sound made at each visit. M. N-, a female, aged twenty-one; single; a servant;.; (Under the care of Dr. HARE.) She has has tubercle of both lungs in a state of HÆMATURIA, or bloody urine, is oftentimes a symptom of been ill but two months, and then had giddiness and a little followed by a little cough, but no dyspnœa. Qr the presence of calculi in the kidney, but as this condition of the urine may proceed from a variety of causes, without some palpitation of the heart. Soon afterwards, and not before, she other concomitant symptoms, the physician would not under- lost flesh and strength, and had swelling of the feet. She had also on the level of the left nipple, which passed up to the take to diagnose the presence of renal calculus. When, there- left shoulder. She is now thin, very excitable, and has nushed fore, we meet with severe pain in one or both loins, with cheeks, with much debility and dyspnœa on exertion. There hæmaturia, occasional fits of inflammation of the kidney, and a is but little cough or spitting. The appetite and digestion are clear enlargement of the organ, as was present in the following good. Tongue clean and bowels regular. The pulse is 136, and respiration 34 per minute; and the vital capacity is only case, we may feel pretty sure there is a stone. In the male sex, cubic inches. fier height is 5 ft. 0 in. On the right side, in addition to these signs, there is not unfrequently irritation 50 there IS great dulness on percussion universally, YYSLli Vury and retraction of the testicles. The correctness of the diagnosis feeble and short efforts and a cavity. On the left inspiratory was verified by the passage of a small calculus, which proved side, the dulness is chiefly below the third rib, with harsh to be oxalate of lime. This form is rare from the kidney, but respiration and indistinct signs of a cavity at the third intercostal space, stretching across the chest in the left side. At a very remarkable case of the kind is given by Dr. Watson in his work " On the Practice of Physic," in which a small this place, there is a short, sharp thrill with each pulsation of the heart, and there are three between the inspirations. It is mulberry calculus, studded with crystals was voided, the not heard during inspiration, because the inspiratory-sound has general symptoms partaking more of those of ordinary colic. a similar tone and quality, and is louder, but it is heard immeThe oxalate of lime calculus is generally known by its nodu- diately the inspiration has ended, and with the expiration, and lated shape and resemblance to a mulberry, but as these are in the interval between the inspirations. It is heard when the not seen in small specimens, its true nature may readily be breath is held in expiration, but it is then of a softer quality, and seems a little more distant. It is not heard when the determined by heating a crystal or piece of it on platinum foil breath is held in inspiration. There is a double sound at-the by means of a spirit-lamp and blow-pipe. The oxalic acid base of the heart, but at the apex the sounds are normal Both becomes converted into carbonic acid, which is driven off by pulses are synchronous with the sound under discussion, and and regular. There is no thrill when the hand is strong heat, and lime remains, easily known by its turning are distinct over the heart or the lungs, and no peculiar movement placed brown when powdered on turmeric paper. in the arteries or veins, but the action of the heart feels We are indebted to Mr. F. B. White for the notes of the fol- tumultuous. She never had pain at this spot, nor any sign lowing case :but palpitation, and that during a fortnight only. In a fortnight the sound was still audible at the same place, E. C-. a female aged thirty-four, rather stout, of florid complexion and healthy appearance, was admitted as out- but somewhat less extensive. The respiratory sounds are still patient on July 8th, 1858, suffering great pain in the region of harsh, short, and wavy. She is no worse. In ten days furtherthe right kidney, which pain had existed more or less severely the sound is still distinctly heard, but it is not heard when she since the Sunday previous. She stated that she had had at whispers. times uneasy sensations in the right lumbar region for four or Dr. Smith was of opinion that this sound was a modified five years past, but that they had not troubled her much till heart sound, and the sound of the heart could be distinctly about five months ago, when the pain became very severe, and heard at the same time in another tone. The quality of the she passed some and had continued to do so at intervals tone of the sound referred to is much thr.t of a rough bronchial up to the time of her admission. She has also noticed that the respiration. urine has been loaded with gravel on several occasions during C. H-, a shipwright, aged twenty-five, single, has tuthe past three or four years. On manipulation in the region of bercle with a cavity in the right lung, and probably deposited. the kidneys, the right one was found to be somewhat enlarged, the left. His vital capacity is 152 cubic inches. and decidedly tender on pressure; the left appeared natural, On April 30th the heart was healthy. On May 1 dth he comand there was no tenderness. Dr. Hare diagnosed the case a6 plained of pains in the left side with palpitation ; but, except one of renal calculus, and the patient was a foul state of the tongue, he progressed very favourably upon a mixture containing spirit of nitric ether, bicarbonate of potash, .anc through the whole year. On December 24th, Dr. Smit disthe sound referred to in the third space, and-then tincture of.henba.ne, and directed touse warm hip-baths.
- Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum et disseetionum historias, tam aliorum proprias, collectas habere et inter se comparare.-MORGAGNI. De Sed. et Cuus. Morb, lib. 14. Procemium.
softening.
haemoptysis,
pain
blood,
tubercle in
put
for
covered
281