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CASE OF PROTRACTED UTERINE HÆMORRHAGE, WITH SECTIO CADAVERIS.
210 esposes the part, and at the same time affords room for the movements of the surgeon. For the application of leeches to the os and cervix uteri, or to the surface of the vagina, it is equally well adapted, so that the difficulty which at times attends the use of this remedy is hereby much diminished. To accomplish this, two fine wire-gauze tubes are supplied, similar in construction to those cups employed in leeching the surface of the body. One is adapted for the os uteri, (fig. 4,) and slides within the glass tube. The other, for Fig.
the
vagina, (fig. 5,) is made to
4.
fit the outer
or
metallic tube, and
Fig. 5.
occupies the place of the inner one. In the former, one extremity only is open, through -which the leeches, previously placed within
it,
are
brought into immediate contact with the os tincæ, a wire which projects from the other extremity,
by pressing on
and which is attached to a piston, which slides within the tube. In the latter, (fig. 5,) each end is closed, but there is an oval aperture similar to that of the metallic cylinder, within which it should be placed, containing the leeches, with its opening turned in a contrary direction to that of the outer tube. The speculum may then be introduced, and the leeches applied to the affected part, by turning the tube until the two oval openings correspond. This instrument also facilitates the use of topical remedies to the uterus and vagina, so that nitrate of silver &c. may be employed with great accuracy to any given extent. This operation, as well as that of leeching, can be performed without the slightest exposure. Indeed, in the use of this speculum, the person of the patient ought never to be in any way seen, as by adjusting her dress around it, nothing externally but the free end of the tube ’, need be brought into view. I would here desire also to remark, that in offering the above observations, I wish it to be understood that I am very far from advocating the indiscriminate use of the speculum in the investigation of uterine diseases, but simply that whenever its aid becomes essential to correct diagnosis, the instrument I have ventured to bring before the profession will be found well adapted to that end. To the clinical teacher of pathology, I would especially address these remarks, since the instrument therein described presents him with the means of demonstrating to his pupils the various organic lesions of the parts under consideration, whilst at the same time he is enabled to point with his finger to those altera- ’, tions which form the distinctive features of the disease. Thus he ’, is able to adopt those measures for imparting knowledge which, when practicable, are considered indispensable in the investiga- i tion of every other department of pathology. These views are strikingly confirmed by Professor Simpson, in the paper from which I have already quoted. " In urging the necessity of such a physical examination of the uterus in uterine diseases, I endeavoured only to claim for that organ a means of diagnosis which, when practicable, is regarded as indispensable in the case of every other part of the system. In discriminating from each other, for example, the various kinds of morbid affections of the eye, no medical man would trust merely to the knowledge that he might acquire regarding the derangements of vision that might be present, the degree and character of the local and sympathetic pains, the quality and nature of the lachrymal and conjunctival secretions, the accompanying state of the system in general, &c.; he would further, in order to arrive at such an accurate diagnosis as would enable him to institute a rational course of treatment, examine as thoroughly as possible the local structural condition of the organ itself, as the only means of determining in what individual texture or textures, whether the conjunctiva, cornea, lens, &c., the disease was specially localized, and what the precise nature of the morbid action really was in the texture that was affected. In the same way, in a case of extensive morbid irritation of the urinary passages, no surgeon would venture to decide precisely what the extent, seat, and nature of the affection was, and whether renal .vesical, or urethral, until he had made a strict local or physical examination of the urinary organs themselves. He might, by the Kina of functional derangements present, be led to suppose that the morbid irritation was connected with a stone in the bladder, or an enlargement of the prostate, or a stricture of
the urethra, &c.; but he could never be perfectly certain that one or other of these was the cause, until he had instituted, with the finger, sound, &c., a local examination of the parts implicated. It is exactly the same with uterine diseases. The external symp. toms may shew the presence of disease in the uterine organs, and occasionally may be such as to lead us to adopt some opinion as to its nature; but we can never, in any case of the slightest doubt, be certain of its exact character and extent, to such a degree as to serve for guides to our diagnosis, prognosis, and treatment, without we have the aid of the knowledge of the local structural state of the viscus itself." I will now concisely recapitulate the advantages which the use of this instrument affords, of which I have had satisfactoryevidence in my own experience, as well as in that of others. It offers to the profession the means of facilitating the diagnosis of the diseases of the uterus, by removing the chief impediments to the employment of the speculum-namely, the difficulty and uncertainty of its application. It enables the practitioner to expose to his view the precise part he discovers by touch, without risk of disappointment, whether it be the os and cervix uteri, or the surface of the vagina, and likewise to demonstrate it to others. It also simplifies the application of leeches and other topical remedies, without exposure of the person of the patient, and yet with unerring accuracy. And lastly, it accomplishes the ob. ject. never heretofore attained, of employing sintultaneously both visual inspection and tactile examination in the investigation of uterine disease. In conclusion, I am encouraged to hope that the proposals which I have herein advanced will lead to the improvement of diagnosis in a class of diseases on which much information is still wanting, will place in the hands of practitioners the means of achieving this great desideratum, which, at present, engages the attention of comparatively but a few of the profession ; and that it will also aid in improving the treatment of these affections, inasmuch as precise pathological knowledge must ever tend to advance the science of therapeutics. John-street, Bedford-row,
Nov. 1844.
CASE OF PROTRACTED UTERINE HÆMORRHAGE, WITH SECTIO CADAVERIS. By WM. HINDS, Esq. Surgeon, Birmingham. THE following case of death from protracted haemorrhage appears to me sufficiently interesting and instructive to warrant diffusion. Some of the particularsof the case are obligingly furnished me by the experienced gentleman who attended the patient from the commencement.
Mrs. T-, aged thirty-two, after a labour ofabout an hour’s duration, was delivered on the 9th of July last. Considerable
haemorrhage occurred after delivery, but it was checked in no without much difficulty. For the first two very long time, or three days nothing unusual occurred to excite apprehension, although the patient was subjected to mental disturbance, arising from causes of a domestic nature. Up to the fifth or sixth day there had been no appearance of external haemorrhage, but after this
period occasional faintings occurred, together with prostraa slight sanguineous discharge, and on the seventh or eighth day she passed coagula. The prostration of strength continued to increase, and on the nineteenth, ten days after deli-
tion, and
very, I was called to see her, in consultation with the gentleman before alluded to, when I found her in the following state :-She was lying on the back, with little or no power to move even a limb. The lips and cheeks were blanched, and the features exhibited signs of great collapse. She was unable to articulate audibly, and each syllable was separated by an inspiration. The tongue could be protruded only a very little way, and, with the gums, appeared also exsanguine. The pulse approached 140, very small and weak. She had, moreover, foetid vaginal discharges. On placing my hand over the hypogastric region I could distinctly feel the uterus much distended, the fundus forming a large softish tumour, which reached considerably above the brim of the pelvis. There was some little abdominal tenderness. I learned that on the morning preceding my visit she had passed more coagula. Some of these were manifestly putrescent, and on examining them closely I thought I could discover what appeared to be small portions of placenta, in the same state of decomposition. On observing this, I suggested to the gentleman present, that as the haemorrhage had been evidently going on internally for many days, and as there must have been originally an obstacle to the effectual contraction of the uterus, which did not appear to have consisted in mere want of power in the organ, it was by no means improbable that the obstacle consisted of a
211 of death being however, assured by him likely prove advantageous. Now the portion of retained placenta. I that the influences, which yet differed essentially expelled without the slightest evidence of I made up of placenta been its that if of those adherent; that it however; from each other, it is to
was,
having
morbidly
cause
two concurrent
was
was
large,
by no
means
improbable
one
influences could have been arrested in its progress, the other might have been overcome by the resources of nature, aided by medical expedients. The exhibition of the ergot of rye, in the first instance, was doubtless, under the circumstances, a welladvised plan, though the propriety of continuing its administration, although followed at first by some good effects, is not so clear. It proved unequal to the task of emptying the uterus of the coagulated blood, and might possibly contribute in some degree to made, and a few fragments of membrane and small coagula were the depression of the vital powers. I am disposed, therefore, to extracted ; but from the contracted state of the os uteri it was believe that in desperate cases of this nature, and after making a evident that the complete introduction of the hand into the uterus, full trial, perhaps of cold or astringent injections, when not wiht the view of removing its contents, would be a highly painful contra-indicated by severe prostration of the vital powers, it operation at least. It might possibly have been found imprac- would be justifiable, even at the risk of severe irritation to the ticable at this stage of her delivery, and even if practicable it uterus, to make every possible effort at the introduction of the might have been attended with so much irritation of the uterus hand, and thereby to free the organ at once from its contents; as to have been followed by inflammation of the organ. More- for, in the language of Burns, 11 neo remedy can be depended on over, in the state of complete exhaustion under which the patient without the use of the hand and the removal of coagula." In a was labouring, it might at once have been fatai. We deter- great majority of cases, this object being effected, I am persuaded ’mined, therefore, to wait until the next day, and in the meantime that a complete check would be put on the stillicidum of blood; to apply a tight bandage round the abdomen, to use vaginal in- and the patient’s life thereby be saved. Not only would the slow jections in order to destroy the fcetor, to administer small doses bleeding be stopped, but the system would also be freed, to a considerable extent, from the depressing influence on the vital of the ergot of rye, and to stimulate. On the following day we found our patient somewhat better, powers, arising from the absorption of the noxious emanations though still in an exhausted condition. She had passed more ’, from the decomposing coagula. The portion of retained placenta, coagula during the night. The uterus, however, was still much the original cause of the haemorrhage, even if it were still so distended, and evidently almost powerless; but the friends of the adherent as not to admit of extraction, would nevertheless have patient, seeing the slight apparent improvement, were averse to become much reduced in size by the putrefactive process. The any attempt on our part at the introduction of the hand into the subsequent part of the treatment would be sufficiently simple. uterus, an expedient which, as it might have been found imprac- The strength of the patient would require to be supported by ticable, or been followed by untoward consequences, was not means of nourishing food, and perhaps by opium or quinine; and urged. We resolved, therefore, to pursue the same plan as it would be necessary to prevent, as far as possible, the absorption adopted.on the previous day, only to give somewhat larger doses of the products of the decomposition, which must still go on, of the of the ergot of rye, with considerable intervals between each remaining portion of placenta, by means of injections into the three or four doses. Under this plan of treatment there certainly uterus, composed of chloride of lime or other disinfecting agents, and thereby shield the system from the injurious consequences was a marked improvement, apparently, in the course of a day which those products would otherwise induce. or two afterwards, when I took my leave of the case; moreover, the uterus was not to be felt, having receded into the cavity of the Birmingham, Sept. 2, 1844.
that its texture was consistent; and, moreover, that he made a careful examination of it at the time, and did not observe that any part of it was deficient. The indications in this case appeared manifest. In the first place, it was necessary that the distended uterus should be emptied of its contents, with the view of suppressing the internal haemorrhage, and thereby saving the case from a fatal issue, to which it was rapidly advancing. A vaginal examination was
pelvis.
The patient, I understand, was afterwards seen by several medical men, one of whom, I believe, predicted the finding of OR SECRETION OF CARBON a uterine tumour. During the next ten days she continued ON THE FORMATION BY ANIMALS. to pass small portions of coagula, and also to have foetid discharges, the abdominal tenderness increasing. There were also By ROBERT RIGG, Esq. F.R.S. occasional revivals, with alternate sinking, until the 10th of IN a former communication, I described how the experiment August, when she died; a month and one day from the period of delivery. might be made which proves that carbon is an animal formation On a Post-mortem examination, the uterus was found to contain or secretion; and also directed attention to inferences which may be drawn from this principle of animal economy. a small portion of placenta firmly adherent to its sides, and near That animals secrete carbon is an inference which may be to the fundus. But it then contained no coagula, and was contracted to pretty nearly its natural dimensions in the unim- drawn from our knowledge of the weight of carbon in the food, by man. pregnated state. It was ascertained that this woman had had and in the air respired The weight of carbon in the carbonic acid imparted to the one or more falls during pregnancy, which will readily account for the effused blood or lymph constituting the medium of atmosphere by an adult in twenty-four hours, is, according to
adhesion. Two important questions present themselves for consideration in this case-namely, What was the immediate cause of death ?and, What mode of treatment would have been most likely to secure a favourable issue ? There is little difficulty, with regard to the first question, in concluding that death was the result of a mixture of ansemia and asthsenia. There had most likely been haemorrhage internally, more or less, from the time of delivery, caused, no doubt, by the and morbidly-adherent portion of placenta; and perhaps retained increased through the influence of the mental agitation to which the patient had been subjected. The loss of blood, therefore, must have been very considerable during the first ten days, although not sufficient to produce a fatal anaemia. Afterwards, however, the loss of blood must have been much less considerable in quantity, except in reference to the then extremely depressed condition of the system. But in such states, it is well known that the loss of even small quantities of blood may determine the question of life and death. The uterus was found empty; and there had been no discharge of fluid blood immediately previous to death, therefore the depressed condition of the nervous system would have a large share in the fatal issue. This tendency to the depression of the vital powers - to asthænia—would be materially augmented by the absorption of the putrid effluvia arising from the decomposition of the uterine contents ; while to the same cause it is reasonable to ascribe, in part at least, the abdominal tenderness. . ’ Supposing this to be a probable estimate of the cause of death, we may briefly consider the treatment that would have been most ’
Grains.
Menzie’s experiments Lavoissier’s
Pepy’s................................
6,713 6,020 5.950 5,169
Mean...............
5,963
...........................
.......................................
Davy’s
.............................................
Allen and
If
compare the
imparted to the of perspiration, with the weight of the carbon contained in the average quantity of food consumed by an adult, we find that the quantity of carbon given off is greater than that supplied to the body by we
weight
of carbon thus
atmosphere by respiration alone, independently
food. This difference is more apparent in the case of persons who subsist upon scanty diet, such as the inmates of workbouses, prisons, &c. By increasing the number, and by varying our experiments, we find a solution, both of this less and greater difference, between the weight of carbon respired, and that in the food consumed. Animals appear to have the power of secreting carbon out of other bodies, and this power is called into action in an inverse proportion to the food supplied. Diminution in the quan. tity of food is followed by a diminution in the quantity of carbon in the air respired. The difference between the weight of carbon in the air respired, and that in the food, is greater where the animals subsist upon a scanty, than upon a plentiful supply of food. In this paper I shall confine my observations simply to the secretion of carbon. I have, from time to time, subjected a great many articles of
the
vagina, (fig. 5,) is made to
4.
fit the outer
or
metallic tube, and
Fig. 5.
occupies the place of the inner one. In the former, one extremity only is open, through -which the leeches, previously placed within
it,
are
brought into immediate contact with the os tincæ, a wire which projects from the other extremity,
by pressing on
and which is attached to a piston, which slides within the tube. In the latter, (fig. 5,) each end is closed, but there is an oval aperture similar to that of the metallic cylinder, within which it should be placed, containing the leeches, with its opening turned in a contrary direction to that of the outer tube. The speculum may then be introduced, and the leeches applied to the affected part, by turning the tube until the two oval openings correspond. This instrument also facilitates the use of topical remedies to the uterus and vagina, so that nitrate of silver &c. may be employed with great accuracy to any given extent. This operation, as well as that of leeching, can be performed without the slightest exposure. Indeed, in the use of this speculum, the person of the patient ought never to be in any way seen, as by adjusting her dress around it, nothing externally but the free end of the tube ’, need be brought into view. I would here desire also to remark, that in offering the above observations, I wish it to be understood that I am very far from advocating the indiscriminate use of the speculum in the investigation of uterine diseases, but simply that whenever its aid becomes essential to correct diagnosis, the instrument I have ventured to bring before the profession will be found well adapted to that end. To the clinical teacher of pathology, I would especially address these remarks, since the instrument therein described presents him with the means of demonstrating to his pupils the various organic lesions of the parts under consideration, whilst at the same time he is enabled to point with his finger to those altera- ’, tions which form the distinctive features of the disease. Thus he ’, is able to adopt those measures for imparting knowledge which, when practicable, are considered indispensable in the investiga- i tion of every other department of pathology. These views are strikingly confirmed by Professor Simpson, in the paper from which I have already quoted. " In urging the necessity of such a physical examination of the uterus in uterine diseases, I endeavoured only to claim for that organ a means of diagnosis which, when practicable, is regarded as indispensable in the case of every other part of the system. In discriminating from each other, for example, the various kinds of morbid affections of the eye, no medical man would trust merely to the knowledge that he might acquire regarding the derangements of vision that might be present, the degree and character of the local and sympathetic pains, the quality and nature of the lachrymal and conjunctival secretions, the accompanying state of the system in general, &c.; he would further, in order to arrive at such an accurate diagnosis as would enable him to institute a rational course of treatment, examine as thoroughly as possible the local structural condition of the organ itself, as the only means of determining in what individual texture or textures, whether the conjunctiva, cornea, lens, &c., the disease was specially localized, and what the precise nature of the morbid action really was in the texture that was affected. In the same way, in a case of extensive morbid irritation of the urinary passages, no surgeon would venture to decide precisely what the extent, seat, and nature of the affection was, and whether renal .vesical, or urethral, until he had made a strict local or physical examination of the urinary organs themselves. He might, by the Kina of functional derangements present, be led to suppose that the morbid irritation was connected with a stone in the bladder, or an enlargement of the prostate, or a stricture of
the urethra, &c.; but he could never be perfectly certain that one or other of these was the cause, until he had instituted, with the finger, sound, &c., a local examination of the parts implicated. It is exactly the same with uterine diseases. The external symp. toms may shew the presence of disease in the uterine organs, and occasionally may be such as to lead us to adopt some opinion as to its nature; but we can never, in any case of the slightest doubt, be certain of its exact character and extent, to such a degree as to serve for guides to our diagnosis, prognosis, and treatment, without we have the aid of the knowledge of the local structural state of the viscus itself." I will now concisely recapitulate the advantages which the use of this instrument affords, of which I have had satisfactoryevidence in my own experience, as well as in that of others. It offers to the profession the means of facilitating the diagnosis of the diseases of the uterus, by removing the chief impediments to the employment of the speculum-namely, the difficulty and uncertainty of its application. It enables the practitioner to expose to his view the precise part he discovers by touch, without risk of disappointment, whether it be the os and cervix uteri, or the surface of the vagina, and likewise to demonstrate it to others. It also simplifies the application of leeches and other topical remedies, without exposure of the person of the patient, and yet with unerring accuracy. And lastly, it accomplishes the ob. ject. never heretofore attained, of employing sintultaneously both visual inspection and tactile examination in the investigation of uterine disease. In conclusion, I am encouraged to hope that the proposals which I have herein advanced will lead to the improvement of diagnosis in a class of diseases on which much information is still wanting, will place in the hands of practitioners the means of achieving this great desideratum, which, at present, engages the attention of comparatively but a few of the profession ; and that it will also aid in improving the treatment of these affections, inasmuch as precise pathological knowledge must ever tend to advance the science of therapeutics. John-street, Bedford-row,
Nov. 1844.
CASE OF PROTRACTED UTERINE HÆMORRHAGE, WITH SECTIO CADAVERIS. By WM. HINDS, Esq. Surgeon, Birmingham. THE following case of death from protracted haemorrhage appears to me sufficiently interesting and instructive to warrant diffusion. Some of the particularsof the case are obligingly furnished me by the experienced gentleman who attended the patient from the commencement.
Mrs. T-, aged thirty-two, after a labour ofabout an hour’s duration, was delivered on the 9th of July last. Considerable
haemorrhage occurred after delivery, but it was checked in no without much difficulty. For the first two very long time, or three days nothing unusual occurred to excite apprehension, although the patient was subjected to mental disturbance, arising from causes of a domestic nature. Up to the fifth or sixth day there had been no appearance of external haemorrhage, but after this
period occasional faintings occurred, together with prostraa slight sanguineous discharge, and on the seventh or eighth day she passed coagula. The prostration of strength continued to increase, and on the nineteenth, ten days after deli-
tion, and
very, I was called to see her, in consultation with the gentleman before alluded to, when I found her in the following state :-She was lying on the back, with little or no power to move even a limb. The lips and cheeks were blanched, and the features exhibited signs of great collapse. She was unable to articulate audibly, and each syllable was separated by an inspiration. The tongue could be protruded only a very little way, and, with the gums, appeared also exsanguine. The pulse approached 140, very small and weak. She had, moreover, foetid vaginal discharges. On placing my hand over the hypogastric region I could distinctly feel the uterus much distended, the fundus forming a large softish tumour, which reached considerably above the brim of the pelvis. There was some little abdominal tenderness. I learned that on the morning preceding my visit she had passed more coagula. Some of these were manifestly putrescent, and on examining them closely I thought I could discover what appeared to be small portions of placenta, in the same state of decomposition. On observing this, I suggested to the gentleman present, that as the haemorrhage had been evidently going on internally for many days, and as there must have been originally an obstacle to the effectual contraction of the uterus, which did not appear to have consisted in mere want of power in the organ, it was by no means improbable that the obstacle consisted of a
211 of death being however, assured by him likely prove advantageous. Now the portion of retained placenta. I that the influences, which yet differed essentially expelled without the slightest evidence of I made up of placenta been its that if of those adherent; that it however; from each other, it is to
was,
having
morbidly
cause
two concurrent
was
was
large,
by no
means
improbable
one
influences could have been arrested in its progress, the other might have been overcome by the resources of nature, aided by medical expedients. The exhibition of the ergot of rye, in the first instance, was doubtless, under the circumstances, a welladvised plan, though the propriety of continuing its administration, although followed at first by some good effects, is not so clear. It proved unequal to the task of emptying the uterus of the coagulated blood, and might possibly contribute in some degree to made, and a few fragments of membrane and small coagula were the depression of the vital powers. I am disposed, therefore, to extracted ; but from the contracted state of the os uteri it was believe that in desperate cases of this nature, and after making a evident that the complete introduction of the hand into the uterus, full trial, perhaps of cold or astringent injections, when not wiht the view of removing its contents, would be a highly painful contra-indicated by severe prostration of the vital powers, it operation at least. It might possibly have been found imprac- would be justifiable, even at the risk of severe irritation to the ticable at this stage of her delivery, and even if practicable it uterus, to make every possible effort at the introduction of the might have been attended with so much irritation of the uterus hand, and thereby to free the organ at once from its contents; as to have been followed by inflammation of the organ. More- for, in the language of Burns, 11 neo remedy can be depended on over, in the state of complete exhaustion under which the patient without the use of the hand and the removal of coagula." In a was labouring, it might at once have been fatai. We deter- great majority of cases, this object being effected, I am persuaded ’mined, therefore, to wait until the next day, and in the meantime that a complete check would be put on the stillicidum of blood; to apply a tight bandage round the abdomen, to use vaginal in- and the patient’s life thereby be saved. Not only would the slow jections in order to destroy the fcetor, to administer small doses bleeding be stopped, but the system would also be freed, to a considerable extent, from the depressing influence on the vital of the ergot of rye, and to stimulate. On the following day we found our patient somewhat better, powers, arising from the absorption of the noxious emanations though still in an exhausted condition. She had passed more ’, from the decomposing coagula. The portion of retained placenta, coagula during the night. The uterus, however, was still much the original cause of the haemorrhage, even if it were still so distended, and evidently almost powerless; but the friends of the adherent as not to admit of extraction, would nevertheless have patient, seeing the slight apparent improvement, were averse to become much reduced in size by the putrefactive process. The any attempt on our part at the introduction of the hand into the subsequent part of the treatment would be sufficiently simple. uterus, an expedient which, as it might have been found imprac- The strength of the patient would require to be supported by ticable, or been followed by untoward consequences, was not means of nourishing food, and perhaps by opium or quinine; and urged. We resolved, therefore, to pursue the same plan as it would be necessary to prevent, as far as possible, the absorption adopted.on the previous day, only to give somewhat larger doses of the products of the decomposition, which must still go on, of the of the ergot of rye, with considerable intervals between each remaining portion of placenta, by means of injections into the three or four doses. Under this plan of treatment there certainly uterus, composed of chloride of lime or other disinfecting agents, and thereby shield the system from the injurious consequences was a marked improvement, apparently, in the course of a day which those products would otherwise induce. or two afterwards, when I took my leave of the case; moreover, the uterus was not to be felt, having receded into the cavity of the Birmingham, Sept. 2, 1844.
that its texture was consistent; and, moreover, that he made a careful examination of it at the time, and did not observe that any part of it was deficient. The indications in this case appeared manifest. In the first place, it was necessary that the distended uterus should be emptied of its contents, with the view of suppressing the internal haemorrhage, and thereby saving the case from a fatal issue, to which it was rapidly advancing. A vaginal examination was
pelvis.
The patient, I understand, was afterwards seen by several medical men, one of whom, I believe, predicted the finding of OR SECRETION OF CARBON a uterine tumour. During the next ten days she continued ON THE FORMATION BY ANIMALS. to pass small portions of coagula, and also to have foetid discharges, the abdominal tenderness increasing. There were also By ROBERT RIGG, Esq. F.R.S. occasional revivals, with alternate sinking, until the 10th of IN a former communication, I described how the experiment August, when she died; a month and one day from the period of delivery. might be made which proves that carbon is an animal formation On a Post-mortem examination, the uterus was found to contain or secretion; and also directed attention to inferences which may be drawn from this principle of animal economy. a small portion of placenta firmly adherent to its sides, and near That animals secrete carbon is an inference which may be to the fundus. But it then contained no coagula, and was contracted to pretty nearly its natural dimensions in the unim- drawn from our knowledge of the weight of carbon in the food, by man. pregnated state. It was ascertained that this woman had had and in the air respired The weight of carbon in the carbonic acid imparted to the one or more falls during pregnancy, which will readily account for the effused blood or lymph constituting the medium of atmosphere by an adult in twenty-four hours, is, according to
adhesion. Two important questions present themselves for consideration in this case-namely, What was the immediate cause of death ?and, What mode of treatment would have been most likely to secure a favourable issue ? There is little difficulty, with regard to the first question, in concluding that death was the result of a mixture of ansemia and asthsenia. There had most likely been haemorrhage internally, more or less, from the time of delivery, caused, no doubt, by the and morbidly-adherent portion of placenta; and perhaps retained increased through the influence of the mental agitation to which the patient had been subjected. The loss of blood, therefore, must have been very considerable during the first ten days, although not sufficient to produce a fatal anaemia. Afterwards, however, the loss of blood must have been much less considerable in quantity, except in reference to the then extremely depressed condition of the system. But in such states, it is well known that the loss of even small quantities of blood may determine the question of life and death. The uterus was found empty; and there had been no discharge of fluid blood immediately previous to death, therefore the depressed condition of the nervous system would have a large share in the fatal issue. This tendency to the depression of the vital powers - to asthænia—would be materially augmented by the absorption of the putrid effluvia arising from the decomposition of the uterine contents ; while to the same cause it is reasonable to ascribe, in part at least, the abdominal tenderness. . ’ Supposing this to be a probable estimate of the cause of death, we may briefly consider the treatment that would have been most ’
Grains.
Menzie’s experiments Lavoissier’s
Pepy’s................................
6,713 6,020 5.950 5,169
Mean...............
5,963
...........................
.......................................
Davy’s
.............................................
Allen and
If
compare the
imparted to the of perspiration, with the weight of the carbon contained in the average quantity of food consumed by an adult, we find that the quantity of carbon given off is greater than that supplied to the body by we
weight
of carbon thus
atmosphere by respiration alone, independently
food. This difference is more apparent in the case of persons who subsist upon scanty diet, such as the inmates of workbouses, prisons, &c. By increasing the number, and by varying our experiments, we find a solution, both of this less and greater difference, between the weight of carbon respired, and that in the food consumed. Animals appear to have the power of secreting carbon out of other bodies, and this power is called into action in an inverse proportion to the food supplied. Diminution in the quan. tity of food is followed by a diminution in the quantity of carbon in the air respired. The difference between the weight of carbon in the air respired, and that in the food, is greater where the animals subsist upon a scanty, than upon a plentiful supply of food. In this paper I shall confine my observations simply to the secretion of carbon. I have, from time to time, subjected a great many articles of