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OBSTETRICAL SOCIETY OF LONDON. WEDNESDAY, MAY 1ST, 1867.
604 uterus, anda through the hand was then passed its posterior wall detected. Being extremely os
into the
a
transverse rent in
Medical Societies.
faint and exhausted, stimulants were freely administered, and Dr. Robert Lee was sent for. He thought her in a dying
state, and that unless she rallied there was
OBSTETRICAL SOCIETY OF LONDON. WEDNESDAY, MAY 1ST, 1867. DR. HALL DAVIS, PRESIDENT.
further examination, protruding from the vagina
On
a
a
loop
to be done. nothingfound to be
of bowel
was
back by Dr. napkin applied to the external parts. She had some sickness, and remained in such a state of collapse that her case seemed hopeless. Mr. Dunn remained with her THE following gentlemen were elected Fellows: Dr. Mitchell, all night. In the morning the protrusion of bowel had much increased, and it was becoming black. About one o’clock she Dr, Watts, Mr. Bennett, Mr. Neate, and Mr. Parker Young. Dr. EASTLAKE exhibited a case of Complete Epispadias in a was seen by Dr. Tyler Smith, who pronounced the case hopeMale Infant, and drew attention to its extreme rarity. He less, the protruded bowel being black and strangulated. She remarked that instances of epispadias were so seldom met with lingered for five days more, expelling between two and three in this country that but little mention was made of the subject yards of intestine before she succumbed. Dr. Tyler Smith in works on Surgery and Pathology, nor was any allusion to was present at the autopsy, which revealed a transverse rent it found in Sir J. Simpson’s memoir on Malformations, or in in the posterior wall of the uterus, in the interior of which the Dr. Beatty’s paper on Doubtful Sex. Dr. Eastlake further degenerated remains of a firmly adherent placenta were seen. stated that M. Dolbeau, who had written a very comprehensive No microscopical examination was made. Dr. BARNES said the descent of intestine through the rentt treatise on the subject, in describing the difference between was not necessarily fatal. He had seen a case in which rupand had drawn attention to the interhypospadias epispadias, took place during delivery of triplets; all the children esting fact, that in the former, which consisted of a division ture in the corpus spongiosum, the urethra still retained its normal and the separate placentas were expelled. He saw and felt the fold of intestine. The woman was collapsed for some time, course; while in the latter, which consisted in a separation of the corpora cavernosa, the course of the urethra was misplaced. but she quite recovered. A few weeks ago he had seen a case’ The peculiar features in the case exhibited were-firstly, there some miles from town, in which rupture had taken place the previous day, and the fcetus had escaped into the abdominal was no extroversion of the bladder, a condition generally associated with such malformations; secondly, the infant could cavity. The woman had rallied a little from the shock, and gastrotomy, which was performed whilst the patient was under retain its water; and thirdly, the pubic bones were united. the influence of chloroform, seemed to add nothing to the pros Dr. GrBAiLY HEWITT then exhibited some specimens of a but she sank in a few hours. He extracted a large tration; new form of Pessary which he had for some months past emchild with hydrocephalus. With regard to the causes of rupin ployed the treatment of cases of anteversion or anteflexion ture of the uterus, of course they were various ; but one leading of the uterus. It consists of a ring of copper wire covered condition, he was of opinion, lay in the loss of relation between with gutta-percha, and bent into a peculiar shape. The upper the strength of the muscular walls of the uterus and of the part of the ring passes behind the os uteri; the lower part is cervix. In most cases the cervix was not expanded, and the just within the vulva. The middle part of the ring is bent uterine wall gave way before the resistance offered. In a large upwards so as to form two mamillary-shaped arms. When in number of instances there was no disproportion between child position, the uterus cannot fall forwards, being supported by and pelvis. Rupture occurred in women whose strength had the arms in question. This instrument, which is worn with- been reduced by preceding pregnancies-whose muscular sys,out the slightest discomfort, must be adapted, as regards size, tem had lost its integrity. In two cases of this kind he had to the vaginal canal. It does not slip. Dr. Graily Hewitt found the uterine tissue generally weak by degeneration. If stated that he had employed the instrument in a great number were given in such cases before the os uteri was dilated, ergot of cases, and had full reliance on it as a means of treating this of course the risk of laceration was much increased. very intractable form of displacement of the uterus. In cases Some further discussion ensued, in which Mr. Benson Baker, of ante- with lateri-flexion, one arm of the instrument is made Dr. Cleveland, Dr. Hicks, Dr. Playfair, and Dr. Brunton took to project a little more backwards than the other, and the part. uterus can thus be kept in perfect position.
Lee,
and
;
this
was
gently put
a warm
-
0
ON A FATAL CASE OF RUPTURE OF THE UTERUS OCCURRING AT THE EIGHTH MONTH OF PREGNANCY. BY R. DUNK, F.R.C.S.
Reviews and Notices ofBooks.
own the evening of Nov. 13th, 1866, Mr. Dunn was called to Mrs. Sňň, and on the evening of the following day she was On Addison’s Disease: Clinical Lectures on Addison’s Disease, and a Report on DÌ8eases oj the Supra-renal Capsules. delivered of a living child. It was her fourth pregnancy. The last confinement had occurred about twenty months previously, By EDWARD HEADLAM GREEN116W, M.D., F. R. C. P., Conand the labour was natural and her recovery good ; but in her sulting Physician to the Western General Dispensary, first she had to be delivered by the forceps, and both in that Assistant-Physician to the Middlesex Hospital, &c. London: Printed by J. W. Rooke, Paradise-street, Rotherhithe. 1866. and in the second had had adherent placenta and great hapmorrhage. During a visit to Margate in August of the previous amongst recent medical discoveries there is none more reyear, she passed a dead fcetus of about five months ; there was markable than that of a connexion between certain morbid states no flooding, and no placenta followed ; but from that time she was subject to strange feelings about the womb. When Mr. of the supra-renal capsules and a peculiar discoloration of the Dunn was first called on the present occasion, the liquor amnii skin and various striking constitutional symptoms. We take had been suddenly discharged, and there had passed a mem- it for granted that this discovery-due to the late Dr. Addi= branous substance resembling a piece of leather, and which son-is a real and not a false one. It has been very much Mr. Dunn took to be some relic of her former miscarriage. and doubted; but, after duly considering the evicriticised There were no labour pains, and the os uteri was closed. The next evening labour pains set in, and were attended with more dence in the case, we agree with those who recognise Addison’s than ordinary suffering. The os had become fully dilated, and disease as a true and very peculiar addition to our nosology. the pains, though frequent and excruciating, were not effective. Great honour is due to the memory of Dr. Addison-a great After waiting some time, there being no lack of room, but only deal more, in our opinion, than has yet been accorded for this of effective effort, a drachm of ergot infused in boiling water And only less than the honour due to him is the with a dessert-spoonful of brandy was administered. Ener- discovery. due to those who have recognised the real value of his credit getic expulsory pains soon followed, and after three or four such the child’s head was suddenly expelled into the world, ’, discovery, and not allowed it to be forgotten or discredited in with severe pain and screaming. Some difficulty was expe- spite of the premature and lamented death of the discoverer. rienced in extricating the cord from the child’s neck, it being In truth, the discovery had both to be defined and to be conparticularly short. No pain following, the child was assisted firmed by his successors ; and conspicuously worthy of praise into the world, and the patient tightly bandaged up. She was faint and low, and after waiting some time, as no pains came among these, in England, are Dr. Wilks and our present on, the finger was passed along the cord to itsinsertion into author-Dr. Greenhow. There was everything in the nature the placenta, which was found to be firmly adherent. The of this discovery to make it difficult. The combination of ,
into the
a
transverse rent in
Medical Societies.
faint and exhausted, stimulants were freely administered, and Dr. Robert Lee was sent for. He thought her in a dying
state, and that unless she rallied there was
OBSTETRICAL SOCIETY OF LONDON. WEDNESDAY, MAY 1ST, 1867. DR. HALL DAVIS, PRESIDENT.
further examination, protruding from the vagina
On
a
a
loop
to be done. nothingfound to be
of bowel
was
back by Dr. napkin applied to the external parts. She had some sickness, and remained in such a state of collapse that her case seemed hopeless. Mr. Dunn remained with her THE following gentlemen were elected Fellows: Dr. Mitchell, all night. In the morning the protrusion of bowel had much increased, and it was becoming black. About one o’clock she Dr, Watts, Mr. Bennett, Mr. Neate, and Mr. Parker Young. Dr. EASTLAKE exhibited a case of Complete Epispadias in a was seen by Dr. Tyler Smith, who pronounced the case hopeMale Infant, and drew attention to its extreme rarity. He less, the protruded bowel being black and strangulated. She remarked that instances of epispadias were so seldom met with lingered for five days more, expelling between two and three in this country that but little mention was made of the subject yards of intestine before she succumbed. Dr. Tyler Smith in works on Surgery and Pathology, nor was any allusion to was present at the autopsy, which revealed a transverse rent it found in Sir J. Simpson’s memoir on Malformations, or in in the posterior wall of the uterus, in the interior of which the Dr. Beatty’s paper on Doubtful Sex. Dr. Eastlake further degenerated remains of a firmly adherent placenta were seen. stated that M. Dolbeau, who had written a very comprehensive No microscopical examination was made. Dr. BARNES said the descent of intestine through the rentt treatise on the subject, in describing the difference between was not necessarily fatal. He had seen a case in which rupand had drawn attention to the interhypospadias epispadias, took place during delivery of triplets; all the children esting fact, that in the former, which consisted of a division ture in the corpus spongiosum, the urethra still retained its normal and the separate placentas were expelled. He saw and felt the fold of intestine. The woman was collapsed for some time, course; while in the latter, which consisted in a separation of the corpora cavernosa, the course of the urethra was misplaced. but she quite recovered. A few weeks ago he had seen a case’ The peculiar features in the case exhibited were-firstly, there some miles from town, in which rupture had taken place the previous day, and the fcetus had escaped into the abdominal was no extroversion of the bladder, a condition generally associated with such malformations; secondly, the infant could cavity. The woman had rallied a little from the shock, and gastrotomy, which was performed whilst the patient was under retain its water; and thirdly, the pubic bones were united. the influence of chloroform, seemed to add nothing to the pros Dr. GrBAiLY HEWITT then exhibited some specimens of a but she sank in a few hours. He extracted a large tration; new form of Pessary which he had for some months past emchild with hydrocephalus. With regard to the causes of rupin ployed the treatment of cases of anteversion or anteflexion ture of the uterus, of course they were various ; but one leading of the uterus. It consists of a ring of copper wire covered condition, he was of opinion, lay in the loss of relation between with gutta-percha, and bent into a peculiar shape. The upper the strength of the muscular walls of the uterus and of the part of the ring passes behind the os uteri; the lower part is cervix. In most cases the cervix was not expanded, and the just within the vulva. The middle part of the ring is bent uterine wall gave way before the resistance offered. In a large upwards so as to form two mamillary-shaped arms. When in number of instances there was no disproportion between child position, the uterus cannot fall forwards, being supported by and pelvis. Rupture occurred in women whose strength had the arms in question. This instrument, which is worn with- been reduced by preceding pregnancies-whose muscular sys,out the slightest discomfort, must be adapted, as regards size, tem had lost its integrity. In two cases of this kind he had to the vaginal canal. It does not slip. Dr. Graily Hewitt found the uterine tissue generally weak by degeneration. If stated that he had employed the instrument in a great number were given in such cases before the os uteri was dilated, ergot of cases, and had full reliance on it as a means of treating this of course the risk of laceration was much increased. very intractable form of displacement of the uterus. In cases Some further discussion ensued, in which Mr. Benson Baker, of ante- with lateri-flexion, one arm of the instrument is made Dr. Cleveland, Dr. Hicks, Dr. Playfair, and Dr. Brunton took to project a little more backwards than the other, and the part. uterus can thus be kept in perfect position.
Lee,
and
;
this
was
gently put
a warm
-
0
ON A FATAL CASE OF RUPTURE OF THE UTERUS OCCURRING AT THE EIGHTH MONTH OF PREGNANCY. BY R. DUNK, F.R.C.S.
Reviews and Notices ofBooks.
own the evening of Nov. 13th, 1866, Mr. Dunn was called to Mrs. Sňň, and on the evening of the following day she was On Addison’s Disease: Clinical Lectures on Addison’s Disease, and a Report on DÌ8eases oj the Supra-renal Capsules. delivered of a living child. It was her fourth pregnancy. The last confinement had occurred about twenty months previously, By EDWARD HEADLAM GREEN116W, M.D., F. R. C. P., Conand the labour was natural and her recovery good ; but in her sulting Physician to the Western General Dispensary, first she had to be delivered by the forceps, and both in that Assistant-Physician to the Middlesex Hospital, &c. London: Printed by J. W. Rooke, Paradise-street, Rotherhithe. 1866. and in the second had had adherent placenta and great hapmorrhage. During a visit to Margate in August of the previous amongst recent medical discoveries there is none more reyear, she passed a dead fcetus of about five months ; there was markable than that of a connexion between certain morbid states no flooding, and no placenta followed ; but from that time she was subject to strange feelings about the womb. When Mr. of the supra-renal capsules and a peculiar discoloration of the Dunn was first called on the present occasion, the liquor amnii skin and various striking constitutional symptoms. We take had been suddenly discharged, and there had passed a mem- it for granted that this discovery-due to the late Dr. Addi= branous substance resembling a piece of leather, and which son-is a real and not a false one. It has been very much Mr. Dunn took to be some relic of her former miscarriage. and doubted; but, after duly considering the evicriticised There were no labour pains, and the os uteri was closed. The next evening labour pains set in, and were attended with more dence in the case, we agree with those who recognise Addison’s than ordinary suffering. The os had become fully dilated, and disease as a true and very peculiar addition to our nosology. the pains, though frequent and excruciating, were not effective. Great honour is due to the memory of Dr. Addison-a great After waiting some time, there being no lack of room, but only deal more, in our opinion, than has yet been accorded for this of effective effort, a drachm of ergot infused in boiling water And only less than the honour due to him is the with a dessert-spoonful of brandy was administered. Ener- discovery. due to those who have recognised the real value of his credit getic expulsory pains soon followed, and after three or four such the child’s head was suddenly expelled into the world, ’, discovery, and not allowed it to be forgotten or discredited in with severe pain and screaming. Some difficulty was expe- spite of the premature and lamented death of the discoverer. rienced in extricating the cord from the child’s neck, it being In truth, the discovery had both to be defined and to be conparticularly short. No pain following, the child was assisted firmed by his successors ; and conspicuously worthy of praise into the world, and the patient tightly bandaged up. She was faint and low, and after waiting some time, as no pains came among these, in England, are Dr. Wilks and our present on, the finger was passed along the cord to itsinsertion into author-Dr. Greenhow. There was everything in the nature the placenta, which was found to be firmly adherent. The of this discovery to make it difficult. The combination of ,