HOPITAL LA PITIE, PARIS.

857 to all members of the profession, urgently ’written at some future time, the first and : most honourable mention will have to be calling upon them to come forward promptness to aid by every means in theirmade of Sheffield, as the residence of a power the promotion of a grand national great body of medical reformers.—ED. L. medical reform, worthy of themselves and of the country to which they belong, was creditable to the body of practitioners in HOPITAL LA PITIE, PARIS. this place, and especially so to you as their leader. Sir, no sooner did the news arrive in Sheffield, that the medical officers of the EXCISION OF A POLYPUS SITUATED ENTIRELY WITHIN THE CAVITY OF THE Aldersgate-street Dispensary had resigned UTERUS. their offices than at your suggestion a public meeting of the profession in this town was THE following case is an example of one called, at which was adopted a spirited ad- of those bold and successful operations dress, prepared by you, to thelate medical’which, from time to time, may be witofficers of that Institution ; and the ex- nessed at the hospital of La Pitie, in the ample thus set was speedily followed by service of M. Lisfranc. the practitioners of the most important The inconveniences and dangers retowns in the kingdom. The last circum- sulting from uterine polypi are somestance to which I shall allude, is your be- times so great as to render an operation coming the first lecturer on the practice necessary. In the latter case, of medicine in this town. How successful when the tumour is situated in the neck you have been as a teacher we may judgeof the uterus, or within its cavity, proby the high popularity which you enjoy, vided, however, it has descended through among those pupils who have had thethe os tincae into the vagina, all surgeons advantage of your instruction. Finally,, are agreed upon the propriety of removSir, the medical profession are indebted to) ing it at once. English accoucheurs, folyou for aid on all occasions when reforms lowing the precepts of Smellie and Denof abuses have been required, and uprightt man, invariably employ the ligature. and honourable conduct was to be en-- French surgeons, on the contrary, are in couraged. In consideration of thesee the habit of extirpating polypi with the bisvarious circumstances, I now beg to3 toury or scissars; and were we to judge present you, in behalf of fifty-one medical,1 from the cases which we have witnessed practitioners residing in Sheffield and itssin the practice of M. Dupuytren and Liswe should say the operation is atvicinity, with this piece of plate." tended with none of the inconveniences The plate having been presented, on account of which it is excluded from Dr. THOMPSON replied in a very approEnglish surgery. If we remember right priate speech, accepting the gift, and ex- (for we are compelled to speak from his sense of the thus feeling pressing the precepts of Denman, Burns, evinced towards him by this great body of memory), on the of

with I

imperiously

franc,

Gouch, &c., polypi, brethren, assuring them, in are confined to cases extirpation where the tumour has conclusion, that he should ever labour to descended either totally, or in good part, correct abuses, and advance the usefulwithin the cavity of the vagina; they do not ness, respectability, and dignity, of the mention the operation as being applicable

his medical

profession. The plate, which

polypus is perfectly inclosed within the uterus; indeed, a case sists of a waiter or with a rich of this kind is quite beyond the reach of ornamented edge or mounting, lying upon the ligature as employed by English acan antique swage, with the bottom richly coucheurs, and they may therefore be exchased, and the inscription surrounding. cused for not having noticed it. Herbineau was the first who had the The just and appropriate eulogy boldness to attack a polypus above the os passed on the members of the profession uteri, in a case where the orifice of the in Sheffield, by Mr. Boultbee, has our cor- neck was only partillly dilated by the tudial concurrence. The medical practi- mour ; hut what is to be done where the tioners of that town possess a character polypus is perfectly inaccessible, situated for spirited and energetic conduct in fa- so high, that the finger can barely reac h vour of the best interests of the profes- its base, while the patient is worn down sion, which has not been attained by any and exhausted by frequent loss of blocd, isolated body of medical gentlemen in or pain, and general irritation? out of the metropolis, and they have been Authors are silent on this point; the well incited to action by the judicious and ligature is evidently impracticable, nor do excellent example of Dr. Thompson.we know that anv one before M. Lisfranc When the history of medical reform ishas had the boldness or good fortune to to cases where the

is very

massive,

plateau,

con-

858 was now introduced into the the uterus, but the operator found that the traction had acted merely Case. the neck of the uterus, and that the Madame Klet, forty years of age, polypus was situated nearly as high up as delivered of her second child six before. M. Lisfranc now endeavoured to ago. About ten months afterwards she place a ligature of silver wire round the with Levret’s instrument, but commenced to experience pain in the loins, with a dragging sensation and weight in could not succeed ; he then drew down the pelvis. The menses were not depolypus with a hook, but was as unranged in the beginning, but were accom- successful as before; twice the operator panied by unusual pain, and, finally, thought the ligature well placed, but when terminated in a fluor albus. These symp- tightened the wire either broke or slipped toms gradually increased, and about four Another attempt, with Desault’s months back sharp pain was felt in the instrument, also failed. Under these circumstances M. Lisfranc pelvis, extending to the lower the ligature as impracticable, and ties; the woman lost a great deal of blood, and very frequently the uterine resolved upon excision. After frequent assumed the character of labour pains, tractions- with a hook, the base of the poThe strength now gradually gave way; lypus was brought down as far as the the patient’s complexion became yellow, vulva; but the only point of its pedicle and she was reduced to the 10w6st state which the finger could reach was still more by want of sleep and appetite; at this than two inches up. Long flat curved stage of the disease M. Lisfranc was called scissars were guided along the left indicain. The presence of ar. uterine polypus tor towards the point, which was divided: was recognised by touch to be as large as a it gave great resistance. The pedicle was hen’s egg; it was completely contained thus partly detached; and the surgeon within the cavity of the uterus, about an carried the scissars to the other side, cut inch above the os uteri; the neck of the into the body of the polypus, and then organ, tumefied and dilated as in preg- made use of a bistoury, with which he nancy, permitted easily the introduction finally succeeded in removing about half of one or even two fingers ; the polypus the tumour (a6 least it was presumed to be was hard to the touch; its pedicle could half). Somesmall fragments were rebe reached on the right side and in front, moved by the scissars; but as the finger but behind and on the left the finger could could not reach the pedicle on the left side, not reach it. The state of the patient M. Lisfranc renounced all further attempts, rendered an operation necessary;but be- leaving this portion to be destroyed by the fore performing it, M. Lisfranc prepared subsequent suppuration. The patient bore the patient (as he is in the habit of doing this long operation with the greatest fortiFrom the introduction of the speon most occasions) by general baths, in- tude. jections, emollient clysters, rest, and diet. culum to the termination, more than an The effect of this treatment was soon mani- hour elapsed, during which nothing but a fest. During the fifteeen days which pre- little serous blood was lost : there was no ceded the operation, the pains diminished, hemorrhage whatever. The patient was now carried to bed. the hemorrhage was arrested, and the The most severe pain which she experiwoman recovered a little strength. On the l lth of Aug. M. Lisfranc proceed- enced had been caused by the dragging of ed to operate in the following manner :- the uterus. After a few minutes’ repose The patient was placed in the position for the abdomen was examined : it was sensilithotomy. M. Lisfranc introduced his ble to pressure; but with this exception, double-branched speculum into patient experienced nothing but a dull gina, exposed the neck of the uterus, and pain, rising from the hypogastrium to the fixed a hook in the anterior lip of the os loins. She was bled at once; two assistwere left with the patient, to watch tincae; tne .speculum was now withdrawn; the barely complained of a very the appearance of any accident; and she slight pain; the hook was drawn gentlywas ordered an opiate draught every hour, toward the vulva, while an assistant pass- a cataplasm to the abdomen, an emollient ed his hand on the hypogastric region. In lavement, and absolute diet.: less than two minutes the lip was drawn A second general bleeding was pracdown to the orifice of the vulva; it appeared tised six hours after the former one. The pale, thick, and very resistant. As the belly was painful, and disturbed with gas; posterior lip had not followed this move- on the discharge of which there was a mament of descent, a simple hook was im- nifest diminution of the pain. A bloody planted in it, by which it was brought serous fluid was discharged by the vagina: in the evening the pulse was 110. The down on a level with the anterior

extirpate

a

polypus

of the uterus under

The

finger

cavity of

such circumstances.

on was

years

pedicle,

the

aside.

extremiregarded pains

the va- the

patient

ants

one.!

859

patient passedgood night, and slept two hours: in the morning, pulse 86, belly indolent. The same treatment was continued during three days ; after which the patient

IBI

ST. GEORGE’S HOSPITAL. FEMORAL HERNIA.—OPERATION.—

allowed alittle chicken-broth, and soon DEATH. returned to her usual diet. After the seA MAN was admitted during cond day the discharge from the vagina Mr. BRODIE’s accident July 20th, week, with sympbecame fetid, and portions of the tumour toms of hernia ; the bowel remaining were brought away. The fe- had been strangulated down for a week, and he had tidity was combated by emollient injec- had no fecal evacuation during that time, tions every two hours. On the 17th of and when admitted in the afternoon there August (sixth day after the operation) was stercoraceous vomiting from the stothe fetidity of the discharge had (lisapmach. Mr. BRODIE was sent for, and on peared :on the llth M. Lisfranc touched his arrival finding the symptoms thus urthe patient : the uterus had assumed nearly he determined at once to perform its ordinary volume: the neck, still en- gent, the operation. No pupils were present, gorged and open, permitted the finger to therefore, as Mr. BRODIE would quaintly pass through it; but nothing anormal was observe, none witnessed it, and the only found in the uterine cavity. A white dis- account we have gathered of it has been charge still continued; and on the next from that gentleman’s own lips. The man day the patient was able to walk about, stated, on his admission, that he had a merely feeling some sense of weight in double inguinal hernia, but it was evident the pelvis. that afresh portion of bowel had come We extract the foregoing case and , down, forming a femoral hernia, under the remarks from the Gazette Médicale. Thesymptomsof which he then laboured. The most remarkable feature of the operation operation was therefore performed; the is the length of time (an hour) during parts about the sac were much swollen, so as to render it difficult to distinguish the which the uterus was forcibly retained in fascia covering the sac from the sac itself. an unnatural position, without the producUpon cutting into the sac the strangulated tion of any of those inflammatory accidents portion of the bowel was found adherent which we might naturally expect to result to the upper and anterior portion of it, by from long-continued violence. This may recent but tolerably firm adhesions ; these were broken down, but when the stricperhaps be accounted for partly because ture was divided, the portion of the bowel the traction acted more in displacing the it remained contracted, and did nipped by neck of the uterus than thewholeorgan ; not enlarge again to its natural diameter. and partly from the effects of the anti- But little fluid was found in the sac. The bed, and purgatives phlogistic treatment employed by M. Lis- man was sent back to were administered of colocynth, calomel, FRANC to prevent the development of inand croton oil, which relieved the bowels flammation. This is a favourite theory copiously eight or nine times. On the of the surgeon of La Pitié;and, in prac- following morning he was bled; the blood tice, is certainly attended with very be- was buil’ed and cupped, and at 1 p.m. we neficial results. Peritoneal inflammation saw him for the first time. His countewas anxious; his pulse small and was evidently prevented from being deve- nance and there was much pain over jerking, in the not loped present instance, only by the abdominal region on pressure. Mr. the preparatory measures, but by the small BRODIE’S diagnosis of the case was unbleedings practised immediately after the favourable, and he ordered the man to be operation: and we have known M. Lis- again bled in the evening if he should reHe died on the following mornFRANC succeed in curing cold abscess of an quire it. at 8 a.m. ing enormous size by simple incision, taking care to prevent the inflammation of the Post-mortern Examination thirty hours walls of the abscess (which is the cause of after death. all the accidents) by abundant local,abThe convolutions of the intestines from straction of hlnnflthe stomach to the seat of stricture were The length of the operation must be at- enlarged beyond their natural diameter, tributed principally to the time lost in and inflamed in patches along their latevainly attempting to apply the ligature. ral margins, where the membrane of the Had M. LISFRANC decided on excision peritoneum was reflected over them. The from the beginning, it probably would not knot of strangulated bowel was about the size of a large walnut; the intestines behave exceeded a few minutes.

was

’