- Email: [email protected]
MEDICINE, SURGERY, AND MIDWIFERY.
177 I was sent for. Upon my arrival within five minutes after the messenger who had been sent for me, I found the
low,
patient exceedingly prostrate, pallid, cold, and hiccuping; the umbilical cord of the child cold and flaccid in the vagina, from which a continuous stream of blood was issuing; the os
uteri flaccid and dilatable, not dilated; the head of the child had not entered the brim of the pelvis. Finding no time was to be lost in emptying the uterus, I proceeded to turn, giving the patient some cold brandy and water. On passing my hand by the head and shoulders of the child, I found the lying completely detached from the uterus, on the placenta the trunk of child, and I had to pass my hand between it and the walls of the uterus, to reach the feet. In so doing, I could distinctly feel the hands of the midwife through the walls of the abdomen, which she was supporting. I succeeded in bringing the child down by the feet, with its back to the abdomen of the mother; and after a little delay, from the large size of the head, it passed under the arch of the pubis, the placenta immediately following. Administering some more cold brandy and water, I had the satisfaction of feeling the uterus contract firmly under my grasp, and all hsemorrhage ceased. After seeing a firm band placed round the abdomen, I waited until nearly five o’clock, and finding the pulse rising, and the woman calm, I left her in charge of the midwife, with strict directions that she should not be moved for several hours, and on no account to be allowed to raise her body, even to drink. About six o’clock, my servant fetched me from the house of a neighbouring patient, in great haste, a message having been sent to say the woman was dying; and upon reaching her dwelling, I found her in articulo mortis, unable to swallowa little brandy, which I attempted to pour down her throat. She had, to my great surprise and regret, at her own earnest entreaty, been removed into bed, her linen changed, &c. The midwife had not left the house more than ten minutes, when a slight return of haemorrhage, followed by fatal syncope, occurred. About fourteen months previously, she had a twin labour, followed by great haemorrhage, from which she had rallied with great difficulty. On Saturday afternoon, the 30th of January, I made a postmortem examination in the presence of my friend, Mr. Brookes, of Holloway. The body, which was moderately fat, was very pallid; the uterus empty, well contracted, completely blanched, and, as was also the vagina, perfectly entire; the bladder empty, and the whole of the viscera, though bloodless, otherwise healthy. Basinghall-street, July, 1847.
Original Contributions to The Lancet in Abstract.
tion of ether; the prevention of the shock or loss of nervous energy which pain alone must occasion, with the consequent saving of strength, is of incalculable service to patients submitting to long and protracted operations, and often of itself sufficient to turn the scale in favour of the patient, when death would otherwise have been the result. Dr. Hearne details three cases in which he used ether by inhalation: The first was a case of amputation of the thigh by the double flap operation, for scrofulous disease of the knee-joint. The patient was a lad, twelve years of age, and much emaciated. The ethervapour was inhaled for about ninety seconds, and in thirty more the limb was removed, without the boy’s evincing any sign of pain. The stump was dressed with common adhesive plaster. Not a single bad symptom ensued, and the wound was nearly healed at the end of three weeks. The ligatures came awayfourteen days after the operation.-The second case was that of a female, twenty-one years of age, and of very diminutive stature, with a large angular curvature affecting the middle dorsal vertebrse. She had been in labour some time with her first child, but very little progress was made, the os uteri not being larger than a shilling. The presentation was natural; the pelvis very small, but without marked deformity, except that the pubic arch appeared somewhat contracted. The os uteri became well dilated in the course of the next thirty hours, and the head descended fully into the cavity of the pelvis, where it became firmly impacted, so as to necessitate the use of the forceps, prior to which Dr. Hearne, having drawn off the urine with the catheter, exhibited the ether, its administration being carried on at intervals, the evidence of returning sensibility being a sufficient guide for its reapplication. The forceps were applied with some difficulty,in consequence of the close impaction of the head, after which the extraction of the child was practised in the usual manner, and effected in above an hour from the commencement of the inhalation, without the patient evincing the slightest pain. The pulse varied but little during the operation; about 90: the lips and face retaining their accustomed line. The placenta was expelled by natural uterine action in about ten minutes from the birth of the child, and the uterus was soon firmly contracted. The patient soon after became conscious, and declared she had not suffered any pain during etherization. She is now doing well. The child, which weighed seven pounds twelve ounces, was asphyxiated atbirth, but soon recovered.The third case was one of natural labour, in which the ether The conwas exhibited solely to remove physical suffering. tractions of the uterus continued, and the infant was born an hour and a half after the inhalation first took place. The placenta was soon expelled, and both mother and child are going on satisfactorily. Dr. Hearne seems to include among the advantages resulting from the ether inhalation in midwifery, the subsequent non-necessity for the administration of opiates.
MEDICINE, SURGERY, AND MIDWIFERY. MEDICAL
Renal Calculi.
forwards
MR.SANDFORD, of Wigston Magna, Leicestershire, the details of the case of a man, forty-five years of age, who had long suffered from pain in the region of the kidneys, but had not passed either gravel or calculus. ’When the patient. Ctme under the care of Mr. Blunt, Mr. Sandford’s employer, about three months since, the pain in the loins continued, and The pulse was accompanied with sickness, rigors, and fever. was intermittent, the tongue coated; and his appearance was anemiate. Up to within a short time before his decease, the urine was passed freely, and without pain or uneasiness; but incomplete suppression took place three or four days previously,a few ounces of urine only being passed in that time. The action of the heart and lungs then became oppressed, and the patient sunk. The urine which was last passed was found to contain an excess of albumen, its specific gravity being 0.10. Examination, forty hours a_fter death.—Lungs healthy; a quart of serous flnid in the cavity of the thorax, and eight ounces in the pericardium. The heart was flaccid and small; liver rather congested; stomach, spleen, and intestines, with the exception of a small portion of the ileum, healthy. The left kidney was much enlarged. Its pelvis contained a number of calculi, one of which weighed two drachms; its narrow end projected into the commencement of the ureter. The calcutous contents of this pelvis weighed half an ounce and tv-untc-fonr grains. The rightkidney was very small; its calculi weighing about two scruples.
POLITICS.
Dentistry.
Mr. HASTINGS ATKiNSON, dentist, of Manchester, writes to express his opinion, that the mechanical part of dentistry cannot be safely entrusted to any one who is not, in the best sense of the word, a professional man, implying thereby, professed practical dentist. Perfection is absolutely requisite in the execution of any mechanical proceedings about the teeth. Mr. Atkinson adds, that almost all the branches of mechanical. In opposition to the views dentistry are equally entertained by " Consistency," he asserts, and in so doing he is borne out by manifold experience, that although it would be indeed an immense public benefit, if surgeons, at least in remote country places, could really familiarize themselves with the operations for the preservation of the teeth; yet in every instance, he (Mr. Atkinson) has happened to hear of, where this has been attempted by a general practitioner, his operations have been chiefly confined to the use of certain noxious and filthy cements, bought ready made for the purpose, and laid on with a trowel. ** Mr. Atkinson is mistaken in supposing we were desirous of speaking disparagingly of mechanical dentists. Our allusion was rather intended to apply to the men who are engaged to perform the ordinary mechanical work in the preparation of artificial teeth, &.c., from the casts furnished them by the practical dentist. Many of these men have been working goldsmiths, watchmakers, surgical instrument makers, &c., and it would be absurd to call upon such to be registered as long Ether I,ilrolation in Surgical Operations and Midwifery. as they confined themselves to mere mechanical dentistry, Dr. BEAuxE, of Southampton, remarks, that the annihilation under the orders and directions of a properly educated pracof pain is not the only benefit derivable from the administra- tical dentist. The operation of the Medical Registration Bill
pelvis contained
low,
patient exceedingly prostrate, pallid, cold, and hiccuping; the umbilical cord of the child cold and flaccid in the vagina, from which a continuous stream of blood was issuing; the os
uteri flaccid and dilatable, not dilated; the head of the child had not entered the brim of the pelvis. Finding no time was to be lost in emptying the uterus, I proceeded to turn, giving the patient some cold brandy and water. On passing my hand by the head and shoulders of the child, I found the lying completely detached from the uterus, on the placenta the trunk of child, and I had to pass my hand between it and the walls of the uterus, to reach the feet. In so doing, I could distinctly feel the hands of the midwife through the walls of the abdomen, which she was supporting. I succeeded in bringing the child down by the feet, with its back to the abdomen of the mother; and after a little delay, from the large size of the head, it passed under the arch of the pubis, the placenta immediately following. Administering some more cold brandy and water, I had the satisfaction of feeling the uterus contract firmly under my grasp, and all hsemorrhage ceased. After seeing a firm band placed round the abdomen, I waited until nearly five o’clock, and finding the pulse rising, and the woman calm, I left her in charge of the midwife, with strict directions that she should not be moved for several hours, and on no account to be allowed to raise her body, even to drink. About six o’clock, my servant fetched me from the house of a neighbouring patient, in great haste, a message having been sent to say the woman was dying; and upon reaching her dwelling, I found her in articulo mortis, unable to swallowa little brandy, which I attempted to pour down her throat. She had, to my great surprise and regret, at her own earnest entreaty, been removed into bed, her linen changed, &c. The midwife had not left the house more than ten minutes, when a slight return of haemorrhage, followed by fatal syncope, occurred. About fourteen months previously, she had a twin labour, followed by great haemorrhage, from which she had rallied with great difficulty. On Saturday afternoon, the 30th of January, I made a postmortem examination in the presence of my friend, Mr. Brookes, of Holloway. The body, which was moderately fat, was very pallid; the uterus empty, well contracted, completely blanched, and, as was also the vagina, perfectly entire; the bladder empty, and the whole of the viscera, though bloodless, otherwise healthy. Basinghall-street, July, 1847.
Original Contributions to The Lancet in Abstract.
tion of ether; the prevention of the shock or loss of nervous energy which pain alone must occasion, with the consequent saving of strength, is of incalculable service to patients submitting to long and protracted operations, and often of itself sufficient to turn the scale in favour of the patient, when death would otherwise have been the result. Dr. Hearne details three cases in which he used ether by inhalation: The first was a case of amputation of the thigh by the double flap operation, for scrofulous disease of the knee-joint. The patient was a lad, twelve years of age, and much emaciated. The ethervapour was inhaled for about ninety seconds, and in thirty more the limb was removed, without the boy’s evincing any sign of pain. The stump was dressed with common adhesive plaster. Not a single bad symptom ensued, and the wound was nearly healed at the end of three weeks. The ligatures came awayfourteen days after the operation.-The second case was that of a female, twenty-one years of age, and of very diminutive stature, with a large angular curvature affecting the middle dorsal vertebrse. She had been in labour some time with her first child, but very little progress was made, the os uteri not being larger than a shilling. The presentation was natural; the pelvis very small, but without marked deformity, except that the pubic arch appeared somewhat contracted. The os uteri became well dilated in the course of the next thirty hours, and the head descended fully into the cavity of the pelvis, where it became firmly impacted, so as to necessitate the use of the forceps, prior to which Dr. Hearne, having drawn off the urine with the catheter, exhibited the ether, its administration being carried on at intervals, the evidence of returning sensibility being a sufficient guide for its reapplication. The forceps were applied with some difficulty,in consequence of the close impaction of the head, after which the extraction of the child was practised in the usual manner, and effected in above an hour from the commencement of the inhalation, without the patient evincing the slightest pain. The pulse varied but little during the operation; about 90: the lips and face retaining their accustomed line. The placenta was expelled by natural uterine action in about ten minutes from the birth of the child, and the uterus was soon firmly contracted. The patient soon after became conscious, and declared she had not suffered any pain during etherization. She is now doing well. The child, which weighed seven pounds twelve ounces, was asphyxiated atbirth, but soon recovered.The third case was one of natural labour, in which the ether The conwas exhibited solely to remove physical suffering. tractions of the uterus continued, and the infant was born an hour and a half after the inhalation first took place. The placenta was soon expelled, and both mother and child are going on satisfactorily. Dr. Hearne seems to include among the advantages resulting from the ether inhalation in midwifery, the subsequent non-necessity for the administration of opiates.
MEDICINE, SURGERY, AND MIDWIFERY. MEDICAL
Renal Calculi.
forwards
MR.SANDFORD, of Wigston Magna, Leicestershire, the details of the case of a man, forty-five years of age, who had long suffered from pain in the region of the kidneys, but had not passed either gravel or calculus. ’When the patient. Ctme under the care of Mr. Blunt, Mr. Sandford’s employer, about three months since, the pain in the loins continued, and The pulse was accompanied with sickness, rigors, and fever. was intermittent, the tongue coated; and his appearance was anemiate. Up to within a short time before his decease, the urine was passed freely, and without pain or uneasiness; but incomplete suppression took place three or four days previously,a few ounces of urine only being passed in that time. The action of the heart and lungs then became oppressed, and the patient sunk. The urine which was last passed was found to contain an excess of albumen, its specific gravity being 0.10. Examination, forty hours a_fter death.—Lungs healthy; a quart of serous flnid in the cavity of the thorax, and eight ounces in the pericardium. The heart was flaccid and small; liver rather congested; stomach, spleen, and intestines, with the exception of a small portion of the ileum, healthy. The left kidney was much enlarged. Its pelvis contained a number of calculi, one of which weighed two drachms; its narrow end projected into the commencement of the ureter. The calcutous contents of this pelvis weighed half an ounce and tv-untc-fonr grains. The rightkidney was very small; its calculi weighing about two scruples.
POLITICS.
Dentistry.
Mr. HASTINGS ATKiNSON, dentist, of Manchester, writes to express his opinion, that the mechanical part of dentistry cannot be safely entrusted to any one who is not, in the best sense of the word, a professional man, implying thereby, professed practical dentist. Perfection is absolutely requisite in the execution of any mechanical proceedings about the teeth. Mr. Atkinson adds, that almost all the branches of mechanical. In opposition to the views dentistry are equally entertained by " Consistency," he asserts, and in so doing he is borne out by manifold experience, that although it would be indeed an immense public benefit, if surgeons, at least in remote country places, could really familiarize themselves with the operations for the preservation of the teeth; yet in every instance, he (Mr. Atkinson) has happened to hear of, where this has been attempted by a general practitioner, his operations have been chiefly confined to the use of certain noxious and filthy cements, bought ready made for the purpose, and laid on with a trowel. ** Mr. Atkinson is mistaken in supposing we were desirous of speaking disparagingly of mechanical dentists. Our allusion was rather intended to apply to the men who are engaged to perform the ordinary mechanical work in the preparation of artificial teeth, &.c., from the casts furnished them by the practical dentist. Many of these men have been working goldsmiths, watchmakers, surgical instrument makers, &c., and it would be absurd to call upon such to be registered as long Ether I,ilrolation in Surgical Operations and Midwifery. as they confined themselves to mere mechanical dentistry, Dr. BEAuxE, of Southampton, remarks, that the annihilation under the orders and directions of a properly educated pracof pain is not the only benefit derivable from the administra- tical dentist. The operation of the Medical Registration Bill
pelvis contained