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MR. NIX'S CASE OF PLACENTA PRÆVIA.
253
unmedicated
axunge and oil, and found it answer remarkably well, six frictions during three days being sufficient. It will be recollected that Mr. Taylor, surgeon to the Clerkenwell Infirmary, published a book some months since, Extirpation of a Yoluminous Bronchocele by M. Roux. THE LANCET, October 12, 1850, p. 418,) wherein he advoM. Roux presented, some time ago, a patient of his to the (see cates frictions of a like character for the cure of typhus fever, Academy of Medicine, from whom he had successfully scarlatina, &c. It would be highly useful if frictions, with removed a large bronchocele. The man’s age is about thirtyunctuous substances, were more extensively tried in the five, and the tumour, at first very small, had been increasing, simple diseases spoken of by Mr. Taylor and M. Bazin. The ease during the last fifteen years, to the size of two fists, and lay with which the remedy is obtained, and the little risk which principally on the left side of the neck. The swelling was is incurred by its use, would render it inestimable if found somewhat hard, almost immoveable; and seemed firmly especially as regards the treatment of the poor. attached to the larynx. The patient was extremely anxious efficacious, M. Bazin has likewise tried a chamomile ointment, which cures for its removal, and M. Roux, after some hesitation, consented the itch in three frictions. It is composed as follows:-Powder to operate. The incision was made in a longitudinal direc- of fresh white oil, axunge, of each sixteen ounces. chamomile, tion, and ran from the os hyoides to the sternum; M. Roux M. Bazin proposes, therefore, in ordinary cases, that the found it easy to enucleate the growth, with the precaution, ointment be used, (sublimed sulphur, very fine powder, however, of tying the thyroid arteries and some venous trunks sulphur of each two drachms; one yolk of egg; olive oil, one ounce, When the tumour was almost com- and two drachms and a as they came into view. half,) in exceptional cases, either pletely detached, the pedicle, by which it was still connected three frictions with the chamomile ointment, or six with the the was and then divided in with front of the neck, tied, simple oil and axunge.
Foreign Department.
ligature. The only phenomenon worthy of attention, which was noticed during the operation, was a fit of dyspncea, after which the patient experienced an almost complete aphony; this lasted some time after the operation, and even now there is
MR. NIX’S CASE OF PLACENTA PRÆVIA. To the Editor of THE LANCET. much hoarseness left. M. Roux accounts for this circumstance SIR,-My attention has been directed to a case of placental by attributing it to the division of the anterior laryngeal presentation, reported by Mr. Nix, in last week’s LANCET. His nerve. The patient was operated on two months ago,and the practice is excellent, and worthy of all commendation; but his wound is now perfectly cicatrized. The tumour weighed explanation is erroneous. He remarks, 11 I passed my hand about nine ounces and a half; it measured nine inches in cir- through the placenta, and by the feet brought down the child," a cumference, and about seven in its transverse diameter. M. method of proceeding which could not have been adopted, simply Velpeau was afraid that M. Roux’s example would be too because it is impossible. Let us examine the case a little more readily followed by other surgeons under less favourable cir- narrowly, and it will become apparent that this assertion is but a cumstances, and thought the operation very dangerous. At truthful expression. The objects for our consideration, and with the meeting, of the 24th of September, M. Velpeau himself which we have to deal are-1, the power-the hand ; 2, the rebrought forward another case of extirpation of a bronchocele, sistance-placenta ; 3, the fulcrum-liquor amnii and fcetus. which was performed by M. Cabaret, of St. Malo; this was Now, if we attempt to force a passage through the placenta, one successful, as well as a third undertaken by M. Hutin. Some of two things will necessarily happen: either so much violence discussion arose as to the propriety of giving the name of much be used as to offer the chance of uterine laceration, by the goitre to tumours arising on the thryoid body, as well as to pressure exerted on the uterus, through the foetus and liquor enlargement of that gland itself. M. Sedillot contended that amnii; or else, what almost invariably occurs, a portion of the that appellation ought to be confined to enlargements of the placenta gives way before the direct force employed, and the thyroid gland; Messrs. Velpeau and Roux opposed that hand is thus admitted into the uterine cavity. But, for the sake of argument, I will admit that the hand has really made for itself opinion. a passage through the placenta, and that one or both feet have been brought through this orifice; let us then inquire what would Absence of the Uterus and Yagina. in the order of events. The placenta is so far M. DEPAUL has brought before the " Societe Medicale next take place elastic as to embrace tightly any considerable object projected d’Emulation" of Paris, the case of a woman, twenty-two years of age, who is described as follows: The mammae are well through it, and would offer an insurmountable obstacle to the of the child’s nates and body-moreover, it has bethen developed, all the appearances of the female sex are present, comepassage for the time (by being thus situated) a part and parcel of in the external of the normal and parts generation condition; but the vaginal orifice is replaced by a mere depression. The the body of the infant, having only its own adhesion to the uterine walls to oppose to the powerful contractions of the uterus, or the patient has never menstruated, but at the time when the extractive force, or, it may be, both combined. Hence there is no function usually commences she experienced pain and weight in difficulty concluding that the lesser power-the resistancein the abdomen, and a pricking sensation in the breasts. The must give way to the greater ; and were it even true, as is comsame feelings are repeated every month, and she has all the supposed, that the feet have been brought through a symptoms of menstruation except the sanguineous flow. Sexual monly lacerated placenta, the body being unable to pass in this way, desires exist, and the impossibility of satisfying them is a the child would necessarily come into the world with the placenta source of grief to the patient. M. Depaul introduced a catheter into the bladder, and his adherent to its legs. This is the conclusion which all might arrive at by the exerindex finger into the anus, and did not succeed in meeting with cise of a little reason ; but in order to make security further any organ which might be supposed to be the uterus. Towards the inlet of the pelvis, and close to the sacro-iliae synchon- secure, let any person place a recent placenta in a wash-hand and try to effect a passage through it, from either the fretal drosis, he found a little, round, and resisting body, which he basin, or maternal surface; he will at once be convinced of the utter considers as the right ovary. M. Depaul looks upon the case of expecting to perform in the uterus and render unfaas an example of a person without vagina or uterus, but pos- fallacy vourable what he is powerless to effect with every sessing ovaries, and therefore belonging without doubt to the advantagecircumstances, in his favour. female sex. I am the more anxiousto correct this error because it is one of ancient date, and is repeated in nearly all obstetric works, even in Treatment of Scabies. !, those the latest published. The directions usually given are, " that M. BAZIN, physician to the Hopital St. Louis, of Paris, pub- in cases of placental presentation, turning must be accomplished, lished in July, 1850, several cases of itch cured in a few days either by passing the hand between the placenta and uterus, or by frictions with the sulphur ointment all over the body. The through the substance of the placenta." Such a statement as this, same physician confirms; in L’ Union Medicale of November 9, supported by the names of Drs. Denman, Ramsbotham, Conquest, 1850, the efficacy of the treatment, by stating,—" The patients and others, propagated without inquiry, is received without queswho formerly left the hospital after twelve or fifteen days tion, and might be productive of serious results if attempted to be only, and very often came back with a relapse of the disease, carried out in practice. At all events its detection will leave us to are now cured in two or three days." But this is not all, for contend with one mistake the less, and at the same time prove a M. Bazin, finding out that some patients have an insurmount- useful hint to the members of our profession generally to cultiable dislike to sulphur, was induced to try several ointments vate habits of self-thought—self-reliance—in preference to the prepared with essential oils-as those of lavender, thyme, rose- too exclusive dependence upon the °° verba magistri." I am, sir, yours faithfully, mary, &c., and likewise turpentine and mercurial ointment. ROBERT MOLLOY, M.R.C.S., &c. None of these were effectual. He then had the idea of tryingi Amwell-street, Sept.1851. ____
__
I
,
unmedicated
axunge and oil, and found it answer remarkably well, six frictions during three days being sufficient. It will be recollected that Mr. Taylor, surgeon to the Clerkenwell Infirmary, published a book some months since, Extirpation of a Yoluminous Bronchocele by M. Roux. THE LANCET, October 12, 1850, p. 418,) wherein he advoM. Roux presented, some time ago, a patient of his to the (see cates frictions of a like character for the cure of typhus fever, Academy of Medicine, from whom he had successfully scarlatina, &c. It would be highly useful if frictions, with removed a large bronchocele. The man’s age is about thirtyunctuous substances, were more extensively tried in the five, and the tumour, at first very small, had been increasing, simple diseases spoken of by Mr. Taylor and M. Bazin. The ease during the last fifteen years, to the size of two fists, and lay with which the remedy is obtained, and the little risk which principally on the left side of the neck. The swelling was is incurred by its use, would render it inestimable if found somewhat hard, almost immoveable; and seemed firmly especially as regards the treatment of the poor. attached to the larynx. The patient was extremely anxious efficacious, M. Bazin has likewise tried a chamomile ointment, which cures for its removal, and M. Roux, after some hesitation, consented the itch in three frictions. It is composed as follows:-Powder to operate. The incision was made in a longitudinal direc- of fresh white oil, axunge, of each sixteen ounces. chamomile, tion, and ran from the os hyoides to the sternum; M. Roux M. Bazin proposes, therefore, in ordinary cases, that the found it easy to enucleate the growth, with the precaution, ointment be used, (sublimed sulphur, very fine powder, however, of tying the thyroid arteries and some venous trunks sulphur of each two drachms; one yolk of egg; olive oil, one ounce, When the tumour was almost com- and two drachms and a as they came into view. half,) in exceptional cases, either pletely detached, the pedicle, by which it was still connected three frictions with the chamomile ointment, or six with the the was and then divided in with front of the neck, tied, simple oil and axunge.
Foreign Department.
ligature. The only phenomenon worthy of attention, which was noticed during the operation, was a fit of dyspncea, after which the patient experienced an almost complete aphony; this lasted some time after the operation, and even now there is
MR. NIX’S CASE OF PLACENTA PRÆVIA. To the Editor of THE LANCET. much hoarseness left. M. Roux accounts for this circumstance SIR,-My attention has been directed to a case of placental by attributing it to the division of the anterior laryngeal presentation, reported by Mr. Nix, in last week’s LANCET. His nerve. The patient was operated on two months ago,and the practice is excellent, and worthy of all commendation; but his wound is now perfectly cicatrized. The tumour weighed explanation is erroneous. He remarks, 11 I passed my hand about nine ounces and a half; it measured nine inches in cir- through the placenta, and by the feet brought down the child," a cumference, and about seven in its transverse diameter. M. method of proceeding which could not have been adopted, simply Velpeau was afraid that M. Roux’s example would be too because it is impossible. Let us examine the case a little more readily followed by other surgeons under less favourable cir- narrowly, and it will become apparent that this assertion is but a cumstances, and thought the operation very dangerous. At truthful expression. The objects for our consideration, and with the meeting, of the 24th of September, M. Velpeau himself which we have to deal are-1, the power-the hand ; 2, the rebrought forward another case of extirpation of a bronchocele, sistance-placenta ; 3, the fulcrum-liquor amnii and fcetus. which was performed by M. Cabaret, of St. Malo; this was Now, if we attempt to force a passage through the placenta, one successful, as well as a third undertaken by M. Hutin. Some of two things will necessarily happen: either so much violence discussion arose as to the propriety of giving the name of much be used as to offer the chance of uterine laceration, by the goitre to tumours arising on the thryoid body, as well as to pressure exerted on the uterus, through the foetus and liquor enlargement of that gland itself. M. Sedillot contended that amnii; or else, what almost invariably occurs, a portion of the that appellation ought to be confined to enlargements of the placenta gives way before the direct force employed, and the thyroid gland; Messrs. Velpeau and Roux opposed that hand is thus admitted into the uterine cavity. But, for the sake of argument, I will admit that the hand has really made for itself opinion. a passage through the placenta, and that one or both feet have been brought through this orifice; let us then inquire what would Absence of the Uterus and Yagina. in the order of events. The placenta is so far M. DEPAUL has brought before the " Societe Medicale next take place elastic as to embrace tightly any considerable object projected d’Emulation" of Paris, the case of a woman, twenty-two years of age, who is described as follows: The mammae are well through it, and would offer an insurmountable obstacle to the of the child’s nates and body-moreover, it has bethen developed, all the appearances of the female sex are present, comepassage for the time (by being thus situated) a part and parcel of in the external of the normal and parts generation condition; but the vaginal orifice is replaced by a mere depression. The the body of the infant, having only its own adhesion to the uterine walls to oppose to the powerful contractions of the uterus, or the patient has never menstruated, but at the time when the extractive force, or, it may be, both combined. Hence there is no function usually commences she experienced pain and weight in difficulty concluding that the lesser power-the resistancein the abdomen, and a pricking sensation in the breasts. The must give way to the greater ; and were it even true, as is comsame feelings are repeated every month, and she has all the supposed, that the feet have been brought through a symptoms of menstruation except the sanguineous flow. Sexual monly lacerated placenta, the body being unable to pass in this way, desires exist, and the impossibility of satisfying them is a the child would necessarily come into the world with the placenta source of grief to the patient. M. Depaul introduced a catheter into the bladder, and his adherent to its legs. This is the conclusion which all might arrive at by the exerindex finger into the anus, and did not succeed in meeting with cise of a little reason ; but in order to make security further any organ which might be supposed to be the uterus. Towards the inlet of the pelvis, and close to the sacro-iliae synchon- secure, let any person place a recent placenta in a wash-hand and try to effect a passage through it, from either the fretal drosis, he found a little, round, and resisting body, which he basin, or maternal surface; he will at once be convinced of the utter considers as the right ovary. M. Depaul looks upon the case of expecting to perform in the uterus and render unfaas an example of a person without vagina or uterus, but pos- fallacy vourable what he is powerless to effect with every sessing ovaries, and therefore belonging without doubt to the advantagecircumstances, in his favour. female sex. I am the more anxiousto correct this error because it is one of ancient date, and is repeated in nearly all obstetric works, even in Treatment of Scabies. !, those the latest published. The directions usually given are, " that M. BAZIN, physician to the Hopital St. Louis, of Paris, pub- in cases of placental presentation, turning must be accomplished, lished in July, 1850, several cases of itch cured in a few days either by passing the hand between the placenta and uterus, or by frictions with the sulphur ointment all over the body. The through the substance of the placenta." Such a statement as this, same physician confirms; in L’ Union Medicale of November 9, supported by the names of Drs. Denman, Ramsbotham, Conquest, 1850, the efficacy of the treatment, by stating,—" The patients and others, propagated without inquiry, is received without queswho formerly left the hospital after twelve or fifteen days tion, and might be productive of serious results if attempted to be only, and very often came back with a relapse of the disease, carried out in practice. At all events its detection will leave us to are now cured in two or three days." But this is not all, for contend with one mistake the less, and at the same time prove a M. Bazin, finding out that some patients have an insurmount- useful hint to the members of our profession generally to cultiable dislike to sulphur, was induced to try several ointments vate habits of self-thought—self-reliance—in preference to the prepared with essential oils-as those of lavender, thyme, rose- too exclusive dependence upon the °° verba magistri." I am, sir, yours faithfully, mary, &c., and likewise turpentine and mercurial ointment. ROBERT MOLLOY, M.R.C.S., &c. None of these were effectual. He then had the idea of tryingi Amwell-street, Sept.1851. ____
__
I
,