OBSTETRIC CLINIC AT PAVIA.

630

ROYAL JULIUS HOSPITAL AT WURZBURG. THE

of the Admissions, Cures, Deaths, above Institution, from 1798 to 1823.

following Table gives a general view the Lunatic

In the

Department of the

t Admitted

Years

Cured

Discharged Incurable ( Died Males s Maless Fem.

Improved

i

Males Females Males

Femalesbeing curedal

Females5 Males

&c., in

Females

-

1798 to 1801 1802 1803 1804

1805 1806

1807 1808 1809 1810 1811 1812

1813 1814 1815 1816 1817 1818 1819 1820 1821 1822 1823

9 9 9 10 10 9

14 9 5 5 7 12

14

2

9

8 12 10 13 13 12

6 4

4 7 6 8 8 7

9

5 7 6 4 8

2

6

1

5 5 6 4

5

13 16 16 14 16

15

8 10 11 9

9

8 14 8

17 11 1-i 11

15

4

10

14

5 5

258

270

i

16 10 18 13

11 10

2 2 S 8 2

6

5 13

2

2 1 2 1 1 1

2

3

1 1

2 2 2

a

1 t

1 2

1 2 2

1

2

1

8 7 5

1

2 2

1 2 1

161

30

3

32

6

2

2 3 2 1 2 2 1 2 1 1

2 2 2 1 2 3 1 1

-

2 3 1 2 3

6

131

i

1

1 1 1 1 2 1 1 1 2 2

7 16 10 12 6 8

6

-

17

7

I

1

’,

1

’

3 1 2

1

-

2

3

1

-

2

1

1

2

2

1

1

2 3 1

2

1

1 1

S

2 2

2

1 2

3

2

1 1 2

1

.

1 7 S 1 2

1 4 2 8 4

41 38

3 3 3 J 3 9 47

2 2

1 1 1

31

131

Most of the lunatics admitted were between the age of 20 and 40; three were between 13 and 15 ; ten above 50 ; and three above 60. The number of unmarried considerably surpassed that of married lunatics. The greatest number were of the middle and lower classes; of the females, twenty were of rank. The remote causes were-perverted education; excessive sexual indulgence; onanism ; too great abstinence from sexual intercourse ; jealously ; despised love ; domestic discord ; deranged pecuniary affairs ; sudden loss of fortune ; religious fanaticism; Two females abuse of spirituous liquors ; excessive mental exertion ; gambling, &c. became deranged from their husbands haying undergone public punishments.

OBSTETRIC CLINIC AT PAVIA.

a

half ; the oblique, three inches and a half; pubi-coccygean, two inches, and the

the

distance between the two ischiatic protubePrufessor a half. Lovati, who has the superintendence of the obstetric department, was at first incliued to think, that this was a case for the inducuou of premature labour ; but, on further consideration was convinced, that the diameters of the pelvis were too smalt even for this merly subject to rachitis, was, in the eighth operation, and determined upon performtK month of her first pregnancy, admitted into the caesarian section, in case there shouid the hospital. On examination pervaginam the exist no signs of the infant’s death duria; pelvis was found considerably deformed, and labour. After the discharge of the waters, 1 the head of the child was found on the esmuch smaller than usual, the sacro-pubic ameter being not more than two inches and trance of the pelvis, rather large, and per CÆSAREAN OPERATION.

THE

which this following was in are contained operation performed, the report of the above institution for 1327 and 1828:— N. N., aetat. 30, of small stature, and fortwo cases, in

di-

rances, two inches and

631

fectly moveable ;the movements child could be distinctly felt, both externally more and more, at the same time she comand internally. After a consultation with plained of most acute pain in the pelvic rethe Professors Cairoli and Panizza, and a re- gion and the lower extremities, especially reated examination of the pelvic diameters, when walking, and was tormented by insa. of the observed to bend the upper part of the trunk

tLe operation was declared indispensable, tiable hunger; a symptom which other wricsd the spiritual life of the infant having ters, especially Monteggia, have very frebeen secured, by baptising it per vaginam, quently observed in osteomalacia, which her (assicurata la vita spirituale al feto col bat- disease was declared to be. In this state, tesimo per injezione,) was performed by the period of parturition approached, and on Professor Lovati. The incision through the examination per vaginam, it appeared that integuments having been made somewhat on the pelvis was greatly deformed, the horiof the os pubis standing one side of the median line, the gravid ute- zontal branches rus readtly presented itself, was divided in higher than the promontory, and the sacroits middle and upper portion, and the child, pubic diameter being not more than about an tugether with the placenta, extracted. The inch and a half, so that delivery was imposuterus appeared rather torpid, so that it was sible by the natural way. After several found necessary to inject cold water through days of continued pain, the waters were the wound, in order to produce mote ener- discharged, and, on repeated examination, getic contractions, after which, the abdomi- the movements of the child were distinctly nal cavity being cleansed from the extrava- felt, both externally and internally; the os sated fluids, the wound was united bymeans uteri was slightly dilated, though not sufof a few sutures, adhesive piaster, and a so that it might be ascertained bandage. The child was a male, full grown, which part presented. The child was meanand remarkably healthy. For about half an ! while christened per vaginam, and the operahour after the operation, the patient ap- tion was postponed until the following day, peared perfectly tranquil, and almost free when the os uteri being more dilated, the from pain; after this period, however, she child was found to present with the breech. was seized with vomiting and hiccup, and The operation was performed after a consulcomplained of great debility and faintness. tation with, and in the presence of, the ProThe pulse was hardly perceptible, the extre- fessors Cairoli and Panizza, and in the same mitiescold, the skin covered with cold sweat, manner as in the first case. The child. a and the abdomen hot and tumid. These full giown healthy female, was extracted symptoms were con8idered as the effect of along with the placenta ; after an injection hæmorrhage into the peritoneal cavity, from of cold water into the uterus, the wound the torpid state of the uterus; iced lemonade, was closed. The symptoms after the opeuitlr ether, was given internally, and cold ration corresponded with those observed in fomentations made over the abdomen, which the first case, and clearly indicated an interproduced a transitory alleviation, after nal haemorrhage, which appeared, hownLiclr the symptoms returned with increased ever, to be arrested by the use of cold baths. force, and the patient died a few hours after In the afternoon the patient felt much better, the operation. On examination of the body, the hiccup, vomiting, &c., had ceased, but the the abdominal cavity was found filled with abdomen was still swelled, though free from fluid and coagulated blood ; the uterus was pain, even on moderate pressure ; the lochial very flaccid and voluminous ; the wound had discharge was natural, and the pulse trannot united, and the interval between its quil. The patient had eaten a little, and edes, as well as the cavity of the uterus, took the decoction of tamarinds as her common beverage. She passed a very restless was hIled with blood. The second case was that of a married night, and on the following morning comwoman of 36 years, of scrofulous habit, who plained of headach and pain in the abdomen, six years before had been delivered, for the the swelling of which had somewhat subthird time, without any great difficulty. In sided. The child was now for the first time her 31st year, she was taken with violent put to the breast. In the afternoon, the wandering pains over the whole body, which symptoms of internal haemorrhage returned, Ra-e treated as a rheumatico-arthritic affec- and, under the use of cold baths, again subbut frequently returned. Having sub- sided. In the evening she was seized with the pulse was very small and sequently become pregnant for the fourth time, they became more violent than ever, hard ; the abdomen painful and tumid; the and continued almost uninterruptedly, so lochial discharge rather scanty; the bowels thût she was at last obliged to apply for ad- costive. An emollient clyster was injected; mission into the civil hospital, which she the decoction of tamarinds continued, and entered in the fifth month of pregnancy. the patient took a very small quantity of At this period she could not stand up, the light bread. The following night she was 1’e:nal column being evidently curved ante- very restless, and on the next morning voriorly, and, at every attempt to walk; she was mited frequently, and complained of great

I ficiently

sbivering ;

632 faintness. The head was rather affected; sand, he was seized with acute pain in the the pulse very small and quick; the skin left side, pain in the head, and vertigo. The dry and hot; the lochial discharge had al- headach is now gone, but he still complains most ceased; the breasts were collapsed, of great pain and tenderness at the lowest part respiration was hurried, and there was slight of thecardiac region, chiefly of its leftLali; delirium. The external wound was found inability to lie on the left side, difficultoi of healthy appearance. No change was breathing, and dry cough. There isa more made in the plan of treatment. In the than usually dead sound, on percu3sron of evening the above symptoms continued; the cardiac region ; great impulse of the the countenance was pale and collapsed ; left ventricle felt in all the arteries; a loud two blisters were applied to the hypogastric rough sawing sound just before the pulse, region. She passed another very restless heard most distinctly on the left side of night, and died in the afternoon of the fourth sternum, at the upper part of the carolac

day.

On examination of the body, a considerable quantity of blood was found extravasated in the abdomen ; the peritoneum slightly inflamed, and covered with puriform lymph; the uterus completely contracted, and the wound in it almost completely healed. Besides the softening of the osseous part of the pelvis, its cavity was found considerably diminished by osteo-sarcomatous tumours ; and all the bones of the body were found softened, so as to be easily cut with the scalpel, and in some parts without any trace of cancellous structure or earthy matter.-

Annals Univ. d’ Medicina.

ITALIAN HOSPITALS. I.v the

region, but audible nearly all over the chest, occasionally in its stead a small slnil sound, preceded by a slight noise, like suck. ing. There is a purring tlirill, also, most perceptible at the left superior part of car. diac region. Pulse 108, strong and full; and

tongue whitish ; bowels open. On the card foot of his bed is written, Hyper. "

at the

with dilatation of the left ventricle of the heart, and disease of the tricuspid valve; or, at least, a narrowing of the right

trophy,

auriculo-ventricular opening." Ordered, Venesection to a pint ; Submuriate of mercury, 5 grains three times a day, and for diet, slops only. 17. Blood is buffed, but not cupped, and the crassamentum not firm. The pain in his side continues very severe, on accountof of which he has been unable to sleep. Pulse 108, full and strong ; bowels moved twice. Repeat venesection to a pint immediately, and again to-morrow morning. 18. Blood abstracted yesterday not cupped or buffed ; the pain and tenderness of car.

of the Holy Ghost, at the year 1820, 10,572 patients were admitted, of whom 9454 were cured, and 885 died. The hospital is very unfavourably situated, and intermittent fevers of a malignant character are very fre- diac region much diminished; pulse 96, quent in it, especially in the summer months, soft, and less full; bowels open; mouth

Hospital

Rome, during-

during which, the daily average consumption of cinchona amounts to about 50 lbs.; the quantity of bark consumed in Rome and its environs, amounted in 1820 to not less than 10,200 Ibs. In the great hospital at Palermo in 1823, 5149 patients were admitted, of whom 585 died. In the hospital San Bartolo, of 897 patients, 107 died. The mortality at the hospital Santa Teresa was enormous, of 18.5 patients, 84 died. In the foundling house, attached to the great hospital, in the same year, of 590 children who were admitted, 460 died.—Med. Chir. Zeitung. ST. THOMAS’S HOSPITAL. DISEASE OF THE HEART.

slightly affected with the mercury.

19. Mouth sore; better. Omit the sub. muriate of mercury. 21. Free from all and tenderness, excepting soreness of mouth from mercurr: bowels open ; pulse soft and full; less difficulty of breathing. A pint of milk daily. 25. No pain ; much less impulse of leit ventricle, and but little difficulty of breathing; pulse soft and full; bowels open. 28. No pain or tenderness; feels far less beating ; lies as well on the left side as cn the right; breath much easier; impulseci left ventricle much less; auricular sawing sound and thrill also diminished ; mouth still sore ; about two stools daily. 31. Feels so well, that he wishes to lea7: the hospital. Milk diet. Dr. Elliotson observed, that from the 2r,--3:at

pam

pain,, and

even

the cardiac

JAMES PARKER, aged 45, admitted, 16th July, into Abraham’s Ward, No. 9, under the dium, and, on

pressure, : least, of the

tenderness,

region, inflammatory state,

there at

on

was

evident!;

that account, he mercurra care of Dr. Elliotson. States, that three the patient, at the same time that he months ago, whilst wheeling a barrow of him. This case, as well as the two follow-