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CASE OF ENORMOUS DISTENTION OF THE CRANIUM IN A FŒTUS.
218
tail; for whilst we have much that is well any other class on the Indian Establishment, on other tropical diseases, the effect especially among the junior assistants, with of climate in undermining the integrity whom a want of confidence, which time and of the brain, seems to have ’escaped the experience alone can supply, often leads to attention it deserves ; and yet I am con- intense anxiety for the welfare of their pa. written
vinced, from what has occurred within the tients. I am disposed also to think, (as partly conrange of my own practice, that lesions of this with this subject,) that the whole nected or form a directly very organ, indirectly, proportion in the outlets to human ex- present system of capping the troops for large istence. I know the difficulties with which India might be reformed with some advan. the subject is surrounded. I know the tage. There is not a man who has stood accuracy of anatomical knowledge, and the two hours with amusquet in his hand, under Tticety of observation, necessary to detect,a tropical sun, but has execrated the inadethe minuter morbid changes in its organicquacy of the protection on ins head. But structure. The inquiry is full of perilousthe English retain their individuality in all ’importance to the patient, no cases callingcountries, and will, perhaps, long continue to for stricter examination on the part of thecherish their national costume in India, ata surgeon, or more rapid change to a colderlarge sacrifice of health and comfort. London, April, 1830. climate, if disease is established. Often ,
there is
baffling obscurity characterising the symptoms during life, from the first transient giddiness, to the fatal knitting CASE OF ENORMOUS DISTENTION OF THE frown that marks effusion on the surfaces; CRANIUM IN A FŒTUS. sometimes passing unheeded by the sufferer to JOHN WALMSIEY, Esq., SurOccurring himself, and only attracting the attention geon, Hodnet.
’
a
of the most watchful medical observer. In the early and accurate discrimination THE wife ofa tailor, named Blaney, liv. of these cases, we are all, perhaps, suscep- ing at the village of Ollerton, near Hodnet, A medical Salop, the mother of four children, was tible of some improvement. friend who had just been walking round his taken in labour at about six o’clock in the hospital, with a senior surgeon (who appear- morning of the 6th of April, 1830. For ed at that time to be in possession of robust nearly a week previous, she had experi. health and spirits), remarked to me that the enced trifling pains in the lower part of the person in question would certainly fall a abdomen, which she expressed as being un. sacrifice to the first attack of illness he might like those of former labours. On the mornhave. On inquiring his reasons for think- ing in question, however, they had increased ingso, he said, " Mischief is goingon in his considerably in strength and frequency. A head ;" for, in conversing with him he had dark brown foetid mucus was discharged noticed some slight alteration from his usual fiom the vagina inconsiderable quantity on manner, and a little unnecessary pause in examination, and the os tineas was felt dihis conversation, as if endeavouring to re- lated to about the circumference of a sixgain a lost train of ideas. I might have pence. In the course of a few hours the forgotten the circumstance, but it was forced dilatation had somewhat increased, and the on my recollection, about three months vertex was plainly distinguished presenting afterwards, by the sndden death of the per- itself. The woman’s pains were continued son alluded to. I remember well the same with scarcely a moment’s intermission, ungentleman recommending a commandant to til seven o’clock in the evening; and al. ’seeka colder climate with an urgency that though the os uteri had attained its fullest seemed uncalled for by the patient himself, degree of extension, the head still remained and even to his ordinary medical attendant. above the brim of the pelvis, sometimes exThe advice was neglected. He returned to truding itself a little, and afterwards reced. his station with his health apparently re- ing. Very shortly the woman’s pains began established, but died in about two months. to slacken, considerable haemorrhage came I do not mention these as cases of extra- on, and she was manifestly much exhausted. ’ordinary penetration, but merely to show The case was now urgent; the head being that some have acquired a tact of nice obser- completely out of the reach of the forceps, vation in external symptoms, which all may, the hand was cautiously insinuated into the perhaps, arrive at, by patient and attentive uterus, in order, if possible to find and bring investigation, combined with minute post- down the feet; but to whatever part tbe mortem examinations. fingers were directed, nothing could be felt It is to be observed in India, that wherebut a prodigious head, apparently occupying whole cavity. The labour pains having great mental exertion is combined with ceased altogether, the perforator, guided anxiety in official duties, the wear and tean of life is very great; thus the rate of mor-by the fingers, was introduced into the orstality is greater among medical men thari niumimmediately as if a flood-gate had
the
now
219 to me as his been opened, an immense quantity of aque- proof. This is as unintelligible gushed out, to the extent of nearly rejoinder is foreign to the subject. ItI was a gallon; the bones of the head thencol- not my intention, Mr. Editor, when tosent lapsed, and by carrying the index finger my communication to THE LANCET, eninto the orifice made by the perforator, and deavour to convince your very numerous drawing gradually downwards, the faetus was and respectable readers, that my reasoning
ous flaid
powers were of a superior order ; I boast of remarkable case than none ; my object was solely to endeavour to Perhaps this never occurred in the annals of mid. show, that the ergot was not deserving of wifery. The head of the fcetus, when in- that comparative contempt cast upon it by flated to its fullest extent, measured in cir- Mr. Walford, who, I am of opinion, has still cttmference 25 inches; its longest diameter, to learn what cases are proper for its exliimeasured by a line drawn from the vertex to bition, and how to recognise them when the clrin, was 12 inches, and its shortest, they do occur. Mr. Watford tells me, I taken from the eminence of one parietal bone ought to know (which by-the-by I hope -I to that of the other, about 9 inches. The do), that in several varieties of distortion, eyes were large, and placed at a great dis- the difficulty occasioned by it does not extance from each other ; the nose was upon ist equally through the whole process of a levelwith the face, and the nostrils wide for instance, a projection of the proof the sacrum, which would oppose and spreadiu,,; under each, were two large fissures, with a red protruding tumour be- greatly the admission of the foetal head into tween them, giving somewhat the appear- the pelvis, would offer a very diminished ance of a divided hare-lip. The bones ol obstacle to its expulsion from it. What a the cranium were by no means so imperfect- piece of information, and without being a ly ossified, ns in most examples which have quotation too ! Where is the obstetric tyro arrived at maturity. The parietal bones were who requires his memory to be thus refreshimmensely large, expanding from it in the ed? IfMr. Walford mean by this to inmanner of wings. In other respects the sinuate that his two cases were of this defretns, which was a female, had every part o: scription, viz., that the obstruction was itshodyinaperfect state, although consi.overcome, ana. me cnuuren nan descenaeo. derably smaller than natural. Endeavour !into the-pelvis, in order to justify his admiwere made to obtain this singular curiosity , nistration of the ergot in cases of (to use for the purpose of preserving it, but th.his own words) great projection of the friends mere decidedly averse. The woman’;s sacrum, and no deficiency of uterine effort, life has been for some time in great danger ,I am not credulous enough to think they but she is now slowly recovering. were. Why was craniotomy performed, but
extracted entire.
a more
labour; montory
because the no other
by
obstruction could means?.Mr.
be
overcome
VValford eviuces
want or reading authors who have written on the subject, or he would not have committed himself, as he has done, by Rejoinder of Mr. HAWKES to Mr. WALFORD.stating that the proofs in favour of the ergot are only founded upon two or three cases at most, related by each practitioner. 1-beg To tlte Editor of THE LANCET. leave to refer him to the works of Drs. SIR,—It was not my intention to havee I Neale and Dewees. which. I nresnme, he intruded further upon your valuable pages, has not read, in which he will find abunbut, upon reflection, I am induced once dance of evidence in proof of the deobstruent More to request a corner for the insertion of properties of the ergot of rye. To refer the present letter (which shall be as brief as him to French works would be useless, as possible), lest my powerful opponent, Mr. he has evidently not read those of his own Walford, should for a moment imagine that country. No doubt all these writers are in his satirical (for there is not a vestige of error, and Mr. Walford’s opinion (after his ecience in it-peut-etre y a-t-il un peu de administration of the medicine in ° dis_ tranile dans son fait) rejoinder should have torted pelvis") is correct; but he believes the effect of silencing me, and thereby put- he is right, and of course all the profession ting to flight one of its champions (as he thinks solikewise. To be sure, Dr. Weatheterms me), or of leading the profession to rill and others may call the eraot a " stand-. despise, as he has done (by the narration -of ard medicine," but what does that prove’! a hundred failures), that powerful therapeu- Certainly nothing (however well its advotic agent the ergot. Such apprehension. L cates may be known in the profession), when MNrehim, he need not for a moment opposed by such high authority as Mr. Walrish. I am accused of having had no perMr. Walford tells me I neglected the ad- sonal acquaintance with the medicine for vice of all reasouers, who I have voluntarily engaged in a conanalogy. to
great
ERGOT OF RYE.
che-
’
°
,prefer
ford.
which
tail; for whilst we have much that is well any other class on the Indian Establishment, on other tropical diseases, the effect especially among the junior assistants, with of climate in undermining the integrity whom a want of confidence, which time and of the brain, seems to have ’escaped the experience alone can supply, often leads to attention it deserves ; and yet I am con- intense anxiety for the welfare of their pa. written
vinced, from what has occurred within the tients. I am disposed also to think, (as partly conrange of my own practice, that lesions of this with this subject,) that the whole nected or form a directly very organ, indirectly, proportion in the outlets to human ex- present system of capping the troops for large istence. I know the difficulties with which India might be reformed with some advan. the subject is surrounded. I know the tage. There is not a man who has stood accuracy of anatomical knowledge, and the two hours with amusquet in his hand, under Tticety of observation, necessary to detect,a tropical sun, but has execrated the inadethe minuter morbid changes in its organicquacy of the protection on ins head. But structure. The inquiry is full of perilousthe English retain their individuality in all ’importance to the patient, no cases callingcountries, and will, perhaps, long continue to for stricter examination on the part of thecherish their national costume in India, ata surgeon, or more rapid change to a colderlarge sacrifice of health and comfort. London, April, 1830. climate, if disease is established. Often ,
there is
baffling obscurity characterising the symptoms during life, from the first transient giddiness, to the fatal knitting CASE OF ENORMOUS DISTENTION OF THE frown that marks effusion on the surfaces; CRANIUM IN A FŒTUS. sometimes passing unheeded by the sufferer to JOHN WALMSIEY, Esq., SurOccurring himself, and only attracting the attention geon, Hodnet.
’
a
of the most watchful medical observer. In the early and accurate discrimination THE wife ofa tailor, named Blaney, liv. of these cases, we are all, perhaps, suscep- ing at the village of Ollerton, near Hodnet, A medical Salop, the mother of four children, was tible of some improvement. friend who had just been walking round his taken in labour at about six o’clock in the hospital, with a senior surgeon (who appear- morning of the 6th of April, 1830. For ed at that time to be in possession of robust nearly a week previous, she had experi. health and spirits), remarked to me that the enced trifling pains in the lower part of the person in question would certainly fall a abdomen, which she expressed as being un. sacrifice to the first attack of illness he might like those of former labours. On the mornhave. On inquiring his reasons for think- ing in question, however, they had increased ingso, he said, " Mischief is goingon in his considerably in strength and frequency. A head ;" for, in conversing with him he had dark brown foetid mucus was discharged noticed some slight alteration from his usual fiom the vagina inconsiderable quantity on manner, and a little unnecessary pause in examination, and the os tineas was felt dihis conversation, as if endeavouring to re- lated to about the circumference of a sixgain a lost train of ideas. I might have pence. In the course of a few hours the forgotten the circumstance, but it was forced dilatation had somewhat increased, and the on my recollection, about three months vertex was plainly distinguished presenting afterwards, by the sndden death of the per- itself. The woman’s pains were continued son alluded to. I remember well the same with scarcely a moment’s intermission, ungentleman recommending a commandant to til seven o’clock in the evening; and al. ’seeka colder climate with an urgency that though the os uteri had attained its fullest seemed uncalled for by the patient himself, degree of extension, the head still remained and even to his ordinary medical attendant. above the brim of the pelvis, sometimes exThe advice was neglected. He returned to truding itself a little, and afterwards reced. his station with his health apparently re- ing. Very shortly the woman’s pains began established, but died in about two months. to slacken, considerable haemorrhage came I do not mention these as cases of extra- on, and she was manifestly much exhausted. ’ordinary penetration, but merely to show The case was now urgent; the head being that some have acquired a tact of nice obser- completely out of the reach of the forceps, vation in external symptoms, which all may, the hand was cautiously insinuated into the perhaps, arrive at, by patient and attentive uterus, in order, if possible to find and bring investigation, combined with minute post- down the feet; but to whatever part tbe mortem examinations. fingers were directed, nothing could be felt It is to be observed in India, that wherebut a prodigious head, apparently occupying whole cavity. The labour pains having great mental exertion is combined with ceased altogether, the perforator, guided anxiety in official duties, the wear and tean of life is very great; thus the rate of mor-by the fingers, was introduced into the orstality is greater among medical men thari niumimmediately as if a flood-gate had
the
now
219 to me as his been opened, an immense quantity of aque- proof. This is as unintelligible gushed out, to the extent of nearly rejoinder is foreign to the subject. ItI was a gallon; the bones of the head thencol- not my intention, Mr. Editor, when tosent lapsed, and by carrying the index finger my communication to THE LANCET, eninto the orifice made by the perforator, and deavour to convince your very numerous drawing gradually downwards, the faetus was and respectable readers, that my reasoning
ous flaid
powers were of a superior order ; I boast of remarkable case than none ; my object was solely to endeavour to Perhaps this never occurred in the annals of mid. show, that the ergot was not deserving of wifery. The head of the fcetus, when in- that comparative contempt cast upon it by flated to its fullest extent, measured in cir- Mr. Walford, who, I am of opinion, has still cttmference 25 inches; its longest diameter, to learn what cases are proper for its exliimeasured by a line drawn from the vertex to bition, and how to recognise them when the clrin, was 12 inches, and its shortest, they do occur. Mr. Watford tells me, I taken from the eminence of one parietal bone ought to know (which by-the-by I hope -I to that of the other, about 9 inches. The do), that in several varieties of distortion, eyes were large, and placed at a great dis- the difficulty occasioned by it does not extance from each other ; the nose was upon ist equally through the whole process of a levelwith the face, and the nostrils wide for instance, a projection of the proof the sacrum, which would oppose and spreadiu,,; under each, were two large fissures, with a red protruding tumour be- greatly the admission of the foetal head into tween them, giving somewhat the appear- the pelvis, would offer a very diminished ance of a divided hare-lip. The bones ol obstacle to its expulsion from it. What a the cranium were by no means so imperfect- piece of information, and without being a ly ossified, ns in most examples which have quotation too ! Where is the obstetric tyro arrived at maturity. The parietal bones were who requires his memory to be thus refreshimmensely large, expanding from it in the ed? IfMr. Walford mean by this to inmanner of wings. In other respects the sinuate that his two cases were of this defretns, which was a female, had every part o: scription, viz., that the obstruction was itshodyinaperfect state, although consi.overcome, ana. me cnuuren nan descenaeo. derably smaller than natural. Endeavour !into the-pelvis, in order to justify his admiwere made to obtain this singular curiosity , nistration of the ergot in cases of (to use for the purpose of preserving it, but th.his own words) great projection of the friends mere decidedly averse. The woman’;s sacrum, and no deficiency of uterine effort, life has been for some time in great danger ,I am not credulous enough to think they but she is now slowly recovering. were. Why was craniotomy performed, but
extracted entire.
a more
labour; montory
because the no other
by
obstruction could means?.Mr.
be
overcome
VValford eviuces
want or reading authors who have written on the subject, or he would not have committed himself, as he has done, by Rejoinder of Mr. HAWKES to Mr. WALFORD.stating that the proofs in favour of the ergot are only founded upon two or three cases at most, related by each practitioner. 1-beg To tlte Editor of THE LANCET. leave to refer him to the works of Drs. SIR,—It was not my intention to havee I Neale and Dewees. which. I nresnme, he intruded further upon your valuable pages, has not read, in which he will find abunbut, upon reflection, I am induced once dance of evidence in proof of the deobstruent More to request a corner for the insertion of properties of the ergot of rye. To refer the present letter (which shall be as brief as him to French works would be useless, as possible), lest my powerful opponent, Mr. he has evidently not read those of his own Walford, should for a moment imagine that country. No doubt all these writers are in his satirical (for there is not a vestige of error, and Mr. Walford’s opinion (after his ecience in it-peut-etre y a-t-il un peu de administration of the medicine in ° dis_ tranile dans son fait) rejoinder should have torted pelvis") is correct; but he believes the effect of silencing me, and thereby put- he is right, and of course all the profession ting to flight one of its champions (as he thinks solikewise. To be sure, Dr. Weatheterms me), or of leading the profession to rill and others may call the eraot a " stand-. despise, as he has done (by the narration -of ard medicine," but what does that prove’! a hundred failures), that powerful therapeu- Certainly nothing (however well its advotic agent the ergot. Such apprehension. L cates may be known in the profession), when MNrehim, he need not for a moment opposed by such high authority as Mr. Walrish. I am accused of having had no perMr. Walford tells me I neglected the ad- sonal acquaintance with the medicine for vice of all reasouers, who I have voluntarily engaged in a conanalogy. to
great
ERGOT OF RYE.
che-
’
°
,prefer
ford.
which