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ON THE THEORY OF MENSTRUATION.
312 probably it would act as a cause of puerperal convulsion: ON THE THEORY OF MENSTRUATION. of this La Motte and others have recorded cases. It is a very By G. F. GIRDWOOD, Esq. Surgeon, London. old remark, that oedema of the face and neck forms a frequent of the made inteand has the Dr. Lever attack, premonitory sign IN a former communication on the " Theory of Menstruation," * resting observation that albuminuria is present in a majority of in- I directed the attention of physiologists to the following facts:stances. These points will require examination, with special refer1st. That cicatrices do not exist on the surface of the ovaries ence to the different modes in which spinal action may be excited. Such are the principal causes of puerperal convulsions, to the of females who have never menstruated. 2nd. That in those females in whom the catamenial discharge modits agendi of all of which the physiology of the true spinal maris known to have appeared a definite number of times, that row supplies as full and perfect an explanation as we have of the number is found to correspond very closely with the number of causes of any disease whatsoever; and it must be remembered, cicatrices visible on the ovaries, and, that wanting this mode of solution, the whole disease formed, conSid. That in those females, who, having reached old age, and of one of the profoundest enigmas pathology. fessedly, in whom, therefore, menstruation had occurred so many times as Other causes than those which have been given, occasionally to render enumeration difficult, the ovaries present a surface operate on the spinal system, but all act in accordance with the seamed and scarred with cicatrices, so numerous and so aggreadvanced. that Professor Ingleby suspects principles already as to prevent any longer their individuality being detected gated of the mammse may cause convulsions. The skin, too, irritation and enumerated. as an important excito-motor organ, must be studied in relation These facts combine harmoniously to illustrate and confirm the to puerperal convulsions. The same may be said of the liver, beautiful theory of menstruation of Dr. John Power, as developed and other parts supplied by the pneumogastric nerve. jIn conclusion, to give a summary of the whole subject, labour in his essay on the periodic discharge of the human female. As still further illustrative of the same theory, in the present is a function of the excito-motory system, and the-true puerperal convulsion can only occur when the central organ of this system communication it is proposed to shew that the function of men-the spinal marrow, has been acted on by an excited condition of struation is not confined, as is generally believed by the medical profession, individually to the human female, but that the anaan important class of its incident nerves-namely, those passing from the uterine organs to the spinal marrow, such excitementI logue, nay, not the analogue only, but that the identical discharge, depending on pregnancy, labour, or the puerperal state. While exists also in other animals of a lower type of organization. the spinal marrow remains under the influence oB either of these Having placed the facts demonstrative of this opinion in juxtathe hope is indulged that some of the difficulties which stimuli, convulsions may arise from two series of causes-of those position, encompassed the study of this subject maybe removed; and acting primarily on the spinal marrow, or centric causes, and, have be shewn, that so far from it being an isolated and secondly, those affecting the extremities of its incident nerves-- that it may startling fact in nature, the periodic discharge of the human causes of eccentric or peripheral origin. female is to be viewed simply as a phenomenon placed at the head 1. Causes acting immediately on the central organ;of a series of the same character, and the gradual development of 1. Loss of blood. 2. Pressure exerted on the spinal marrow by congestion, which, like the development of all the other phenomena of animated life, is to be traced, in its progress upwards to our own coagula, or serous effusion within the cranium, &c. 3. Asphyxia of the spinal marrow from spasmodic closure ofspecies, through a series of beings progressively rising from a lower genus to a higher in the scale of the animal creation. the glottis. For this purpose it is proposed to shew, by microscopic obser4. The influence of emotion. vations, as well as by chemical analyses, II. Causes acting on the extremities of excitor,nerves:1. That in the lower animals the catamenia appear in them 1. Irritation of the incident spinal nerves of the uterus and -teas well as in the human female ; and that whilst the discharge is rine passages. characterized in them, as in her, by a periodicity peculiar to each 2. Irritation of the incident spinal nerves of the rectum. 3. Irritation of the gastric and intestinal branches of the pneu- separate genus, it is, at least in the higher orders of mammals, equally sanguineous as it is observed to be in woman. mogastric nerve. II. That in all animals in which the periodic discharge is 4. Irritation of the incident spinal nerves of the bladder. 5. As probable causes, may be enumerated, irritation of the apparent, in the human female as well as in other mammals, the cutaneous nerves, the nerves of the mammee, and of the hepatic discharge is indicative of the maturation of an ovum, and of its . and renal branches of the pneumogastric. being on the point of elimination from the ovary ; and that the Though the subject distinctly admits of this division, several capability for impregnation is, during menstruation, at its acme. III. That the periodicity of menstruation, indicative of this causes may act together, and centric and eccentric causes may be in operation at the same time. I have made no attempt at a maturation and impregnability of the ovum, is precisely that division into predisposing and exciting, proximate and remote quality which allies these phenomena to most of the leading phecauses, as other writers have usually done, because it is evident nomena of nature, vital as well as physical, dependent upon that a cause which in one case is the exciting or proximate, may heat; and, like them, even in a being so far removed by civilizain another be the predisposing or remote cause. Thus, irritation tion from physical influences as man; in him they are, as- in of the uterus may be the predisposing, and irritation of the sto- other animals, affected by the seasons. mach the exciting cause, in one instance, while in another, irritaI. tion of the uterus is both the predisposing and the exciting cause; It might be supposed, on a superficial view of this subject, hence any such division must be, to a great extent, arbitrary, and that the domestic animals, from their relation to man, their habits devoid of precise meaning. For instance: Dr. Ramsbotham, in a being under his daily observation, would present the ready means passage I have quoted, says, " the most usual proximate cause of of proving the periodicity of the catamenia in the lower animals. puerperal convulsion is probably pressure on the brain," whereas Such, however, is not the case, for a formidable difficulty in them it can be shewn that cerebral pressure is usually a symptom pro- is experienced in the outset of an inquiry for such a purpose. duced by some exciting cause previously in operation. The same The value of the greater part of animals in a domestic state to authority mentions irritation of the stomach and intestines man, is, in an economic point of view, so great, that their proamong the remote causes, though there can be no doubt of theirpagation is encouraged by him by every artificial means, so that, in being generally exciting causes when they exist as causes of most genera, no sooner does the desire for propagation become indiany kind. cated, than means are taken to have the sensual appetite gratified. The views of the nature and causes of puerperal convulsions, I found opportunities of studying the phenomena in the developed in the present paper, are, as I believe; capable of im- dog, the rabbit, the ox, and the horse, more readily than in any portant practical application in the treatment and prevention of: other animals, and it is to them that the following observations the disease. This branch of the subject I propos.t(} consider in principally refer. a future communication. Having examined circumstances in these animals, of which some will be proved, on inquiry, to be identical with those that Bolton-street, Piccadilly, 1814. exist in our own species, we compass more readily the phenomena of the periodic discharge of the human female. And thus, much A Prussian captain had been affiicted with asthma for several of the wonderment with which menstruation has so universally years. He took the wet sheet at Graefenberg, in which. he per- been contemplated will be at an end. We wonder at events and on which we consider singular; when they are proved to be analogoing into the cold bath, immediately died! spired, M. Dzubo, a captain in the Austrian service, had been some gous to others with which we are conversant, our astonishment months under treatment at Graefenberg, when thecrisis appeared ceases. Physiologists wonder at the regularity with which the in the form of a tumour in the throat. It burst internally, and he instantly expired. There is no surgery employed. Nature.and * Published in THE LANCET, March 4th, 1843. ;ccttd water are to do all. &dag er; Essays on the Female (Economy. London, 1821. most
.
,
.
.
.
.
313
periodic discharge of the human female returns, because, in bodies, of an; ovoid form, transparent, and averaging the 160ootli respect to this phenomenon, they consider the female of our spe- of an inch in diameter. The regularity of the return of these cies is isolated from all the rest of the animal creation. Indeed, symptoms is greatest during the spring and summer; as the cold
midwifery published in this country-by weather approaches, it becomes less so. The heat is not noticed author whose opinions on the subject of which he treats, from during lactation, but returns as soon as this duty is over-the the industry shewn by him in his inquiries, merit much respect,- very next day the animal indicates her desire for re-impregnation. The cestrum affects the horse, during the early part of summer, it is stated that " the function of menstruation is peculiar to the human species."* every fortnight; the desire gradually passes off as autumn apThis observation, deliberately recorded as the opinion of a proaches. I find it existing in the end of July, but it is rare. writer of extensive research in that branch of the profession to The heat lasts for two or three days, passes away, and returns in which he has especially directed his energies, whilst it embodies the period stated. The discharge is often profuse; it consists of the opinions of most contemporary authors, is but a repetition of a yellow, strong, odorous fluid, of the consistence of oil. Glothe previously announced opinions of Muller, in his " Elements bules, various in size, some half a thousandth of an inch in diaof Physiology." The words of the German physiologist are as meter, abound in it; all have an ovoid form; no nucleus apparent. " follow:-" Menstruation, in the strict sense, is peculiar to the On standing, it separates into a transparent, yellow, seroushuman female." This distinguished writer, in the paragraph looking fluid, and a whitish flocculent precipitate: the fluid has a from which I quote, attempts to shew that the catamenialdis- mild alkaline re-action, contains a little albumen, is rendered turcharge is in no way allied to the sexual heat in the lower animals. bid, but does not coagulate by heat and nitric acid; it contains chlo-" He concludes his statement on this subject with the following ride of sodium and earthy phosphates: there is no fibrine present." remark:-"The menstruation of the human female is a pheI am indebted for the above analysis, as well as for that which nomenon.of a totally different nature, and has no connexion with follows, to the kindness of my friend, Dr. Day, whose contribusexual excitement."t tions on the normal and diseased condition of the urine are well These opinions phenomena in the human female, known and appreciated. I have preserved the fluid for five months in a phial, corked, considered to isolate her from all other animals, are those in which the medical profession in general participate. If these and as yet it shews no signs of putridity. views have not the authority of nature for their support, they I observed a few blood corpuscles in the fluid escaping from a have, at the least, the authority of antiquity. " Woman is the only mare the day after she had received the male, but in all the e-xanimal that menstruates." " Solum autem animal menstruale amples I had for observation I did not detect any previous to mulier est," is the sentence with which Pliny commences, in copulation. In this case the sanguineous discharge may have his fifteenth book of his Natural History, his extraordinary been the result of introition: it was a maiden mare. I have found that during lactation in the horse, as in the ox opinions on this phenomenon in the human female-opinions, it may be added, that have had the widest and most popular disper- the cat, and, as is well known, in our own species, the develop sion, but which are now as void of interest, as they are of truth. ment of ova occurs, and impregnation takes place. I am acSo far from the Stagyrite being of opinion that the K6
respecting
’
&Dag er; C. Plinii Nat. Hist. lib. 15, de menstruis mulierum.
$ Dr. Robert Grant’s Lectures, LANCET, 1833-34, p. 1034.
*
Skillet, Treatise
on
Parturition of the Cow,
London, 1807.
&xed
and other matter destructible -at a red 3.9. The fibrine was digested in water for a considerable and then in boiling alcohol and ether: it was afterwards dried till it ceased to lose weight. The quantity is remarkable." I have stated that the catamenial fluid in the ox is not always sanguineous. It is often transparent, remarkably viscid, and has
salts, 0.9; albumen,
heat, time,
the appearance and consistence of jelly. In new-born calves, the cornua and uterus are filled with this transparent secretion. It is endowed with great plasticity, and I apprehend it is from this quality (when the periodic discharge of oxen, in addition to this glairy character, has that of sanguinity superadded) that the blood corpuscles so readily and universally assume the linear and moniliform arrangement which I have attempted to portray in the unpretending sketch taken from the miscroscope, and accompanying this communication. In the dog, the periodic discharge occurs generally every twelve or sixteen weeks, and remains for several days; eight or ten, commonly. The dog is generally in heat three times a-year, and the catamenia follow at intervals, less distant in summer than in winter. In many individuals, two periods annually only are experienced; in a few, only one period. I have, again, found other individuals having the secretion appearing every eight or nine weeks. The sanguineous nature of the discharge in the dog is strongly characterized. I have submitted the secretion to a microscopic comparison with normal blood, taken from a puncture in the ear of an animal whilst menstruating. The colourless as well as the red corpuscles were as evident in the menstrual fluid as in the blood: of course, the admixture of mucus made them appear, in the field of sight, fewer in number than in the latter fluid, whilst the existence of masses of epithelium floating with them in the fluid characterized the secretion. Superadded to these appearances, I noticed what I have not remarked to have existed in any normal blood-the existence of corpuscles of the same diameter as the blood discs, but differing I from them in shape. Those I allude to are perfectly transparent, colourless-or, at least, much paler than the red blood corpuscles. Their outline, instead of being smooth, as in the blood disc, is studded regularly with prominences; and these prominences exist over the surface generally, as was ascertained by repeated examinations; for this apparent animalcule, in its free and rather rapid evolution through the fluid, from rolling over and over, presented every portion of its periphery for inspection. Donne states, that the addition of water to blood occasions the discs to become globular. This being the case, the menstrual fluid, so much thinner than blood, may, acting like water, account for the globular appearance of these bodies, but will not explain their apparent tubercular surface; nor will their spherical shape allow them to be considered simply as blool discs, assuming the usual mulberry outline of corpuscles becoming desiccated. The following sketches* give a faithful representation of the microscopic appearances in the catamenial fluid of the horse, the 6x, the rabbit, the dog, and man.
THE OX.
THE RABBIT.
spherical,
THE DOG.
MAN.
indebted for an interesting communication respecting John Percy, of Birmingham. Dr. P. states that he has had constant opportunities of observ ing the female mandril and drill (papio morma and P. leucophceas) during the last four years. *’ At intervals of about six or eight weeks, the labia become uncommonly distended, red, and The swelling proceeds gradually, and attains its maximum in about five days or a week. It then gradually declines, and a small quantity of sanguineous discharge makes its appearance11generally, though, so far as I have observed, not uniI have kept a female Chinese bonnet monkey, (cerformly." copathecus radiatus,) during five years, in apparent perfect health. At intervals of about six or eight weeks, after passing I
am
quadrumania to Dr.
THE HORSE.
* These sketches are not drawn on the same general scale. Mr. Gulliver (in his Appendix to Gerber’s Anatomy) has rendered us familiar with the relative size of the bloo.l corpuscles of various animals. The object in view in these sketches was, to give the best idea I could, in the space, of the relative sne of the different things seen in each separate group ; thus, whilst the secretion from the rabbit is sketched from the appearances seen by a Powell’s one-sixteenth of an inch focus g!as and long eye-piece, the others are all taken by the use of the one-eighth of an inch focus glass-the secretion of our own species being seen through the short, the others, through the In all may be seen, abundantly, scales of epithelium. In the dog and ox, the form of these scales is more definite than in the other sketches. In the latter, they are often nearly a perfect circle, and the nucleus well defined, probably from being more recent than those which present a polyhedral outline. I have not had any specimens from man or the ox, shewing any signs of vitality. ’ In the former, in the sketch, may be observed the grouping of the discs into rouleaus, so often noticed in human blocd, and which, to save a periphrasis, may be termed their nummilifnrm arrangement. In the sketch from the dog, the secretion of which animal has always shewn the usual vital phenomena, may be noticed discs of a perfectly normal, vital character; whilst others indicate the collapsed and shrivelled outline caused by dessication. The minute objects so abundant in this secretion, represent the primary condition (?) of the blood discs; whilst in the disc, apart from the others, the attempt has been made to delineate the appearance of the disc of normal size alluded to in the text, as studded with granular looking bodies on the periphery. The first, second, and last sketches are rude efforts of my own. I am indebted to the practised pencil of Mr. Lens Aldhous for the others.
long eye-piece.
’
shining.
much mucus,
exactly resembling transparent jelly, a sanguineous discharge generally appears." Dr. Percy’s experience is confirmed by that of others to whom I have applied for information. These phenomena existing in the lower genera of mammalia are such as ought to remove the human female from the state of isolation in the animal creation in which physiologists are, in general, with regard to this secretion, disposed to place her. It is evident the secretion in the lower animals is as periodic as in her. She has her cycle of time; they each have theirs. Although the cycle of our species may, as the normal standard, be stated to be twenty-eight days, yet there exists so much variety, that each individual woman may be said to have a cycle of her own. It is seldom we meet- with two women who are simultaneously unwell for any number of periods together, and yet,
315 when periodicity is well established in an
82.50 individual, how unerringly, Aqueous particles and 10.90 the re-appearance of the periodic solution its arrival every thirty days; some, 6.58 every 28th; some, every 25th day; and some can depend with Dr. Rainy, Professor of Forensic Medicine in the University confidence on its return every 21st day. One young lady lately of Glasgow, and Dr. Macconechy, analyzed a quantitv of menunder my care had it regularly, for several periods in succession, strual it blood, obtained by puncturing an imperforate every Monday three weeks; another experienced the phenomenon was beginning to get putrid, and evolved ammonia on the addiI for A months together. lady attended tion every third Sunday, Under the microscope, the globules were seen as last year haddischarge every fortnight; each alternate period numerous as in ordinary blood, but their shape was somewhat she looked upon only to be the catamenia; her reason for this as is the case with putrid blood. It was composed ofirregular, opinion was, because it was doubly profuse to the one preceding. 885.5 Water From the facts that have been collected, it would appear that 114.5 Solid residue in passing up through the series of animal beings, the nearer we the more the catamenial ofman, serum was The approach discharge approximates composed in character that of our own species. It would appear, that in Water......................................... 912.8 all it consists of a profuse periodic flow of the usual mucous Solid residue 87.2 secretion of the organs of generation, with, in the higher genera Dr. concluded Hence that blood the consisted ofof animals, the of some more Rainy generally, portion, Serum or less, of blood diffused in the secretion, and from this, its diffu972.2 Globules 27.8 sion, deprived of its usual quantity of coagulation. By some authors, indeed,.the menstrual fluid of women is stated never to ’ No fibrine could be detected. The serum containedcoagulate. This peculiarity, in their opinion, stamps the secreWater 912.8 tion with a character peculiar to it. By other authors, it is, on Albumen....................................... 77.0 the contrary, stated to possess this usual quality of the blood. It Chloride of sodium 6.0 must be familiar to every practitioner in midwifery to have seen Soda 0.2 the secretion sometimes present the one character, sometimes the Animal matter and earthy phosphates... 4.0* other. The disposition to coagulation exists the strongest in those individuals in whom the secretion is the most profuse. At The following is the analysis of Simon, of Berlin. The fluid the present time there is under my examination the menstrual was taken at a time when it contained scarcely any epithelium fluid of a patient in which coagulation is unequivocally demon- scales. It did not coagulate ; it contained some vaginal mucus but it was not putrid, nor of an unpleasant odour. strated. It has been said not to become putrid, and that in cases where, It contained in 1000 partsthe hymen being imperforate, on an operation laying open the Water 785.00 canal to the os uteri, the fluid for years pent up in the vagina 215.00 Solid constituents has indicated no symptom of putridity. In the opinion of some, 2.58 Fat............................................. this has been viewed as an inexplicable phenomenon. But those Albumen 76.54 who consider the non-putridity of this fluid, under such circum120.40 Hæmatoglobulin stances, inexplicable, forget its nature. It is but blood mixed 8.60 Extractive matter with, and rendered thin by mucus. Chemists have discovered in Simon observes, that "the most striking peculiarities of this the secretion the constituent elements of blood; some have detected fibrine in it, whilst others, whose accuracy is unquestion- blood are, the total absence of fibrine, and the increase of the solid able, have been unable to* detect it in the specimens they have constituents caused by the excess of the blood corpuscles. The .subjected to examination.* Microscopic examination leads to the colouring matter amounted to 8.3 per cent. of the hsematoconclusion that it is blood attenuated by the local secretions. Such globulin." The facts that have now been submitted to the reader, as illusbeing the case, it is not remarkable that it should indicate, under such circumstances, no putridity. Blood extravasated in unin- trative of the catamenia in other female mammals besides the female, will have their full weight with the physiologist; jured cellular membrane shews no disposition to putridity. In human and yet, even after all that has been adduced in proof of their it and in the is there deposited, coagulates, simple ecchymosis It is only when the structure identity, there may still exist in his mind the startling objection course of time is re-absorbed. around is injured or unhealthy that it takes on the character of referred to as being that of Müller, and he may, like him, consider the analogies still to be imperfect, inasmuch as, whilst in the putridity. But in the catamenia, the blood is so mixed with the lower animals the period of the catamenia is among them the increased, although natural, glairy mucous secretion of the surfaces of the uterus and vagina, that it remains fluid; and as there period only in which, in general, they admit sexual intercourse, as no disposition in blood itself, when deposited within a healthy it is, on the other hand, the time when woman shuns the society structure, to decay, what is there in mucus to excite putridity? of the male. The experience of society, however, leads to a conWhen do we find the secretion natural to a surface, ever in that clusion the reverse of this opinion of Milller, and the knowledge surface a cause of unhealthy excitement ? The bile pent up in possessed by the observant man of the worid more truly illustrates .the gall bladder becomes inspissated, not putrid. The glairy the matter than the speculations of the philosopher. Were the latsecretion of the salivary glands arrested in the duct, and con- ter to leave his closet, and enter society in search of truth, he would, of the opinion of Müller, soon perceive that he was mistaken; stituting ranula, on puncture, invariably is healthy and trans- if and when his mind had compassed the philosophy of the subject, parent. It ought not, therefore, to be a matter of surprise that the if not a misanthrope, but a lover of his species, he would re-enter natural discharge of the catamenia retained within a sac formed his cabinet with his philanthropy augmented, and more especially his respect for the sex profoundly exalted. Before he reby the healthy mucous membrane of the vagina should remain an with indefinite period uncorrupt and of local disturbance. turned to his privacy, he would be struck with admiration of the It may be well here to add the latest chemical analyses of the influence exercised by moral culture on the feelings and passions of humanity, and he would more especially not fail to observe the human menstrual fluid. marvellous power exercised by civilization§ on the mind of her The following is an analysis by Denis:— who, from her social position, is rendered the charm of man’s Water 82.50 existence. Her social position has rendered woman keenly perFibrine...................................................... 0.05 cipient of every thought or action beautiful or graceful, and her
,generally, can she calculate discharge! Some look for
.....................
InIn suspension
TOTAL
on
in globules......
..............................
hymen:
of potash.
.........................................
.................................
.................................
super-addition,
..........................................
.......................................
..........................................
........................
...........................................
.......................................
.........................
....................................
...........................
and salts ............
unproductive
......................................................
Hæmatosin Alucus
...............................................
......................................................
Albumen................................................... Oxide of iron ............................................ Red
phosphoric,
and traces of white
6.34 4.53 4.83 0.05
phosphoric ?
0.39 greaseof each..................... .....} Osmazome 0.11
and cruorine,
Subearbonate and hydrochlorate of soda, 0.95 hydrochlorate of potash, each .....................) of lime 0.25 and Carbonate, phosphate Traces of phosphate of magnesia.....................
and
..................
-
*
Vide Warwick’s Essay on this subject in the Medical Gazette, March 29, Mr. W. has shown great research in his essay, and has given an analysis of most of the conflicting opinions on this subject. &dag er; No. 333. L’Experience, Rakiborski’s Essay.
1844, p. 863.
*
Thomson’s
Chemistry, p. 375.
&dag er; Anthropochemie. p.
’
234.
monkey is observed receive satirical
Berlin,
Ed. 1843. 1842.
the embrace of the male at all times,. to t The and Aristotle states, that the mare is disposed to sexual intercourse even Dean of St. Patrick was in error after impregnation; so that the when he stated the yahoo to be the on:y animal that would admit the male whilst she was pregnant." § It may be considered that the infiuence of civilization is here too highly rated. But Locke has shewn us how there can be no innate ideas. AU mental phenomena must depend on the senses; all moral, on education. The knowledge of sex itself, may it not rest on educaiioii ? Two years ago, an aggravated case of hypospadia (or hermaphroditism) came under my observation. On account of this peculiarity of arrested development, the young man had been brought up from infancy as a female. All the mental phenomena that were exhibited in this individual were those of the female, not of the male sex. Timidity, gentleness, and bashfulness, existed ia. excess.
316 sensitively on the watch to shut out from contem- and the pains, although occasionally stronger affected the pre’plation everything of an opposite character. Taught from infancy sentation not in the least. The head could not be said to be imto subjugate her passions and affections, her thoughts, her looks, pacted, for in some parts of the circumference of the pelvis, the her language, are kept under control. She simulates health when examining finger could be passed up by the side of it with no ill, ease when in pain, and contentment is expressed by her smile great difficulty. I thus discovered an ear behind the-pubis, and when her heart is torn with agony. Need it be a matter of the position to be that of the face directed to the right ilium. The --wonder, when we see her capable of such self-restraint in patient was getting fatigued, but there was no extraordinary exgeneral, that she should retire within herself, and exercise that citement of the vascular system, no inordinate heat of the genitals, control we find her continually exerting over all her thoughts and consequently no indication for depletive treatment. The case and actions, the more energetically, at a time when she is taught was one of arrest of the head rather than of impaction, and that a stray thought of desire would be impurity, and its fruition nature appeared to have been sparing in her efforts, lest mischief pollution.* To aid her in such a duty, nature has wisely pro- should be done. vided her with the sexual appetite slightly developed.t Considering the difficulty in the case to depend partly upon the In this respect she may be placed in the same category as the position of the head not being the most favourable, and partly females of all other mammals. Man, on the other hand, and the also, in all probability, upon some disproportion between its males of all mammals, must be placed, in respect to sexual desire, dimensions and those of the pelvis, I determined upon the employin a category of their own. In him, as in them, the passion ment of the long forceps, as the preferable mode of treatment exists in a state of exaltation, hurrying him, when uncontrolled, under the circumstances. into a state of degradation, and frequently into crime. It being ascertained that the bladder and the rectum were empty, I carefully introduced and applied the forceps along the sides of (To be continued.) the pelvis, with a little inclination of the respective blades towards the acetabulum on the one hand, and the sacro-iliac junction on the other. Applying traction, and resting alternately, I gradually ON A. NEW REMEDY FOR PSORIASIS. brought the head down past what appeared to me to be the point of difficulty, and at the same time directed the face to the right to JOSHUA the WADDINGTON, Esq. Consulting Surgeon By sacro-iliac junction. Having thus placed the head in a favourable Royal Sea-Bathing Infirmary, Margate. and brought it partly down into the cavity of the pelvis, of as as the WITH the view public rendering possible easy position, I now removed the instruments, preferring that nature should hermeans I have for some time past adopted of speedily subduing a self alone effect its further descent, as also the dilatation of the very common, and, if treated improperly, a very dangerous disin her own best and safest time, and the more especially I THE of the extensive circulation of avail ease, LANCET, perineum, myself as it was a case of first parturition, rather than, by continued efforts of the that in the treatment or to state, psoriasis diffusa, palmaria, of traction, expose that and the other soft structures lining the best application is the ol. palm. cocc. (cocoa-nut oil,) diluted with pelvis to risk of injury. The pains, however, proved not to be should be of The affected cectacei. parts ung. portions equal for this purpose; I therefore recommended washed every night and morning with tepid rain water, then sufficiently propellent the ergot of rye to be given, there being no contra-indication a made quite dry, and the ointment applied lightly, (with of it at the present stage of the case. The malposition camel’s-hair brush;) over this, oiled-silk should constantly be to the use of the head had been corrected; the head had been brought past worn. I need scarcely remark, that pilul. hydr. sub. comp. (Plummer’s the seat of difficulty; there was no heat, nor dryness, nor rigidity of the soft passage; the orifice of the uterus had been dilated long pill,) gr. x., each night at bed-time, with liq. potassæ, m.xx., ago, otherwise I could not have legitimately employed the forthree times a day, are among the best internal means of treating the outlet of the pelvis was at least of average dimensions, ceps ; no with care as psoriasis diffusa, joined great regards regimen: salted meats, no shell-fish, no fermented liquors, no acids; the if not above them. I thus hoped to supersede the further employment of the above instrument. The ordinary quantity less fruit and vegetables the better. After twenty-eight years’ extensive practice at the sea-side, which I employ of the above medicine, that of half a drachm of I venture to add, that warm or cold sea-bathing is not generally the fresh powder, given at intervals of ten and fifteen minutes, in advisable in cases of psoriasis diffusa, and have often been at- infusion, was exhibited for three doses; a brisk action was induced, and with some good effect, for the head further descended tended with dangerous results. At some future period, when professional avocations are fewer into the cavity of the pelvis, and came to bear against the outlet and less pressing, I intend to submit to the public a more par- of the passage; but here it was again arrested, on account, as ticular account, both of my theory and practise, as regards subsequently proved to be the fact, of the child being conThe head, however, had above the average size. psoriasis, and other eruptive complaints, accompanied with a siderably mind is always
descended within the reach of the short forceps, and with a view life, I completed the delivery with that instrument, cautiously and slowly, and with due regard to the safety of the perineum, about six P.M. The child being born in an apoplectic condition, with an extremely turgid face, and incapable of breathing, a table-spoonful CONTRIBUTIONS IN MIDWIFERY. of blood, by measure, was allowed to flow from the divided cord, when the child speedily exhibited signs of By J. HALL DAVIS, M.D., Physician to the Royal Maternity vessels of the and cried. The size of the child was considerably life, breathed, Charity. above the average, its weight being nine pounds and a half. There Difficult Parturition—Delivery by the Forceps-Remarhs on the was a firm hour-glass contraction of the uterus, which being overeffects of Operations with the Forceps, and the Prophylactic come by time and patience, the placenta was removed by the Treatment. hand without any difficulty. There was no haemorrhage. On the following morning we met at eight. Our patient had OCTOBER llth, 1843, at two P.m., I was requested by a meThe slept four or five hours, from the effect of a draught containing dical friend to meet him in a case of difficult labour. patient, the subject of it, was twenty-one years of age, and of thin one grain of morphia. She had passed water without difficulty, habit of body. She had previously enjoyed good health. It was and was free from pain; but, nevertheless, the skin was dry and her first child. The liquor amnii had escaped twelve hours pre- hot, there were thirst, restlessness, a tongue coated with a white viously. Her pains had been of moderate strength and frequency fur, a pulse 90, with some activity about its beat, and not for the first few hours, but latterly they had been weaker, and at readily compressed; a scanty lochial discharge. We therefore of taking blood from the arm. Twenty longer intervals. The orifice of the uterus, my friend informed agreed in the propriety me, had become fully dilated shortly after the discharge of the ounces flowed in a full stream without our patient fainting, waters. I found, on examination, a protrusion of scalp, but the although in a sitting posture. The skin, however, having head itself had not descended in any degree into the pelvic cavity, exchanged its dryness for moisture, and lost its excessive temperature ; and the pulse having softened, the patient, moreover, * In the Rambler, vol. i. No. 39, the sorrow and suffering entailed on expressing herself as feeling cooler and more comfortable, the arm woman from her social position, and borne by her in silence, are elegantly was tied up. The bowels were opened by a dose of castor oil, and feelingly described by Johnson. That original author, Mr. Alexander and a saline diaphoretic, containing tartarized antimony, was given Walker, in his book" °° On Intermarriage," 1838, expresses opinions similar to at intervals. An antiphlogistic regimen was enjoined. On our what 1 have detailed. t The reader may be startled at this proposition; but if he doubts it, he visit on the following day, the blood taken exhibited a strongly is referred to Heywood’s Our patient was going on satisTYNAIKEION," and Alexander’s History of buffed and cupped surface. Women," which teem with examples of this constitutional indifference ; and the pulse was soft, and 80 beats; the skin of natural if still desirous of further proofs of a like character, he is referred to the factorily ; temperature, and moist; and the discharge of lochia had customs of the Hottentots and Kamskatckans, alluded to by Lord Kaimes
I have treated. Marine-terrace, Margate, Nov. 22, 1844.
schedule of the
cases
"
in his
"
Sketches of Man."
to the child’s
"
increased.
.
,
.
.
.
.
313
periodic discharge of the human female returns, because, in bodies, of an; ovoid form, transparent, and averaging the 160ootli respect to this phenomenon, they consider the female of our spe- of an inch in diameter. The regularity of the return of these cies is isolated from all the rest of the animal creation. Indeed, symptoms is greatest during the spring and summer; as the cold
midwifery published in this country-by weather approaches, it becomes less so. The heat is not noticed author whose opinions on the subject of which he treats, from during lactation, but returns as soon as this duty is over-the the industry shewn by him in his inquiries, merit much respect,- very next day the animal indicates her desire for re-impregnation. The cestrum affects the horse, during the early part of summer, it is stated that " the function of menstruation is peculiar to the human species."* every fortnight; the desire gradually passes off as autumn apThis observation, deliberately recorded as the opinion of a proaches. I find it existing in the end of July, but it is rare. writer of extensive research in that branch of the profession to The heat lasts for two or three days, passes away, and returns in which he has especially directed his energies, whilst it embodies the period stated. The discharge is often profuse; it consists of the opinions of most contemporary authors, is but a repetition of a yellow, strong, odorous fluid, of the consistence of oil. Glothe previously announced opinions of Muller, in his " Elements bules, various in size, some half a thousandth of an inch in diaof Physiology." The words of the German physiologist are as meter, abound in it; all have an ovoid form; no nucleus apparent. " follow:-" Menstruation, in the strict sense, is peculiar to the On standing, it separates into a transparent, yellow, seroushuman female." This distinguished writer, in the paragraph looking fluid, and a whitish flocculent precipitate: the fluid has a from which I quote, attempts to shew that the catamenialdis- mild alkaline re-action, contains a little albumen, is rendered turcharge is in no way allied to the sexual heat in the lower animals. bid, but does not coagulate by heat and nitric acid; it contains chlo-" He concludes his statement on this subject with the following ride of sodium and earthy phosphates: there is no fibrine present." remark:-"The menstruation of the human female is a pheI am indebted for the above analysis, as well as for that which nomenon.of a totally different nature, and has no connexion with follows, to the kindness of my friend, Dr. Day, whose contribusexual excitement."t tions on the normal and diseased condition of the urine are well These opinions phenomena in the human female, known and appreciated. I have preserved the fluid for five months in a phial, corked, considered to isolate her from all other animals, are those in which the medical profession in general participate. If these and as yet it shews no signs of putridity. views have not the authority of nature for their support, they I observed a few blood corpuscles in the fluid escaping from a have, at the least, the authority of antiquity. " Woman is the only mare the day after she had received the male, but in all the e-xanimal that menstruates." " Solum autem animal menstruale amples I had for observation I did not detect any previous to mulier est," is the sentence with which Pliny commences, in copulation. In this case the sanguineous discharge may have his fifteenth book of his Natural History, his extraordinary been the result of introition: it was a maiden mare. I have found that during lactation in the horse, as in the ox opinions on this phenomenon in the human female-opinions, it may be added, that have had the widest and most popular disper- the cat, and, as is well known, in our own species, the develop sion, but which are now as void of interest, as they are of truth. ment of ova occurs, and impregnation takes place. I am acSo far from the Stagyrite being of opinion that the K6
respecting
’
&Dag er; C. Plinii Nat. Hist. lib. 15, de menstruis mulierum.
$ Dr. Robert Grant’s Lectures, LANCET, 1833-34, p. 1034.
*
Skillet, Treatise
on
Parturition of the Cow,
London, 1807.
&xed
and other matter destructible -at a red 3.9. The fibrine was digested in water for a considerable and then in boiling alcohol and ether: it was afterwards dried till it ceased to lose weight. The quantity is remarkable." I have stated that the catamenial fluid in the ox is not always sanguineous. It is often transparent, remarkably viscid, and has
salts, 0.9; albumen,
heat, time,
the appearance and consistence of jelly. In new-born calves, the cornua and uterus are filled with this transparent secretion. It is endowed with great plasticity, and I apprehend it is from this quality (when the periodic discharge of oxen, in addition to this glairy character, has that of sanguinity superadded) that the blood corpuscles so readily and universally assume the linear and moniliform arrangement which I have attempted to portray in the unpretending sketch taken from the miscroscope, and accompanying this communication. In the dog, the periodic discharge occurs generally every twelve or sixteen weeks, and remains for several days; eight or ten, commonly. The dog is generally in heat three times a-year, and the catamenia follow at intervals, less distant in summer than in winter. In many individuals, two periods annually only are experienced; in a few, only one period. I have, again, found other individuals having the secretion appearing every eight or nine weeks. The sanguineous nature of the discharge in the dog is strongly characterized. I have submitted the secretion to a microscopic comparison with normal blood, taken from a puncture in the ear of an animal whilst menstruating. The colourless as well as the red corpuscles were as evident in the menstrual fluid as in the blood: of course, the admixture of mucus made them appear, in the field of sight, fewer in number than in the latter fluid, whilst the existence of masses of epithelium floating with them in the fluid characterized the secretion. Superadded to these appearances, I noticed what I have not remarked to have existed in any normal blood-the existence of corpuscles of the same diameter as the blood discs, but differing I from them in shape. Those I allude to are perfectly transparent, colourless-or, at least, much paler than the red blood corpuscles. Their outline, instead of being smooth, as in the blood disc, is studded regularly with prominences; and these prominences exist over the surface generally, as was ascertained by repeated examinations; for this apparent animalcule, in its free and rather rapid evolution through the fluid, from rolling over and over, presented every portion of its periphery for inspection. Donne states, that the addition of water to blood occasions the discs to become globular. This being the case, the menstrual fluid, so much thinner than blood, may, acting like water, account for the globular appearance of these bodies, but will not explain their apparent tubercular surface; nor will their spherical shape allow them to be considered simply as blool discs, assuming the usual mulberry outline of corpuscles becoming desiccated. The following sketches* give a faithful representation of the microscopic appearances in the catamenial fluid of the horse, the 6x, the rabbit, the dog, and man.
THE OX.
THE RABBIT.
spherical,
THE DOG.
MAN.
indebted for an interesting communication respecting John Percy, of Birmingham. Dr. P. states that he has had constant opportunities of observ ing the female mandril and drill (papio morma and P. leucophceas) during the last four years. *’ At intervals of about six or eight weeks, the labia become uncommonly distended, red, and The swelling proceeds gradually, and attains its maximum in about five days or a week. It then gradually declines, and a small quantity of sanguineous discharge makes its appearance11generally, though, so far as I have observed, not uniI have kept a female Chinese bonnet monkey, (cerformly." copathecus radiatus,) during five years, in apparent perfect health. At intervals of about six or eight weeks, after passing I
am
quadrumania to Dr.
THE HORSE.
* These sketches are not drawn on the same general scale. Mr. Gulliver (in his Appendix to Gerber’s Anatomy) has rendered us familiar with the relative size of the bloo.l corpuscles of various animals. The object in view in these sketches was, to give the best idea I could, in the space, of the relative sne of the different things seen in each separate group ; thus, whilst the secretion from the rabbit is sketched from the appearances seen by a Powell’s one-sixteenth of an inch focus g!as and long eye-piece, the others are all taken by the use of the one-eighth of an inch focus glass-the secretion of our own species being seen through the short, the others, through the In all may be seen, abundantly, scales of epithelium. In the dog and ox, the form of these scales is more definite than in the other sketches. In the latter, they are often nearly a perfect circle, and the nucleus well defined, probably from being more recent than those which present a polyhedral outline. I have not had any specimens from man or the ox, shewing any signs of vitality. ’ In the former, in the sketch, may be observed the grouping of the discs into rouleaus, so often noticed in human blocd, and which, to save a periphrasis, may be termed their nummilifnrm arrangement. In the sketch from the dog, the secretion of which animal has always shewn the usual vital phenomena, may be noticed discs of a perfectly normal, vital character; whilst others indicate the collapsed and shrivelled outline caused by dessication. The minute objects so abundant in this secretion, represent the primary condition (?) of the blood discs; whilst in the disc, apart from the others, the attempt has been made to delineate the appearance of the disc of normal size alluded to in the text, as studded with granular looking bodies on the periphery. The first, second, and last sketches are rude efforts of my own. I am indebted to the practised pencil of Mr. Lens Aldhous for the others.
long eye-piece.
’
shining.
much mucus,
exactly resembling transparent jelly, a sanguineous discharge generally appears." Dr. Percy’s experience is confirmed by that of others to whom I have applied for information. These phenomena existing in the lower genera of mammalia are such as ought to remove the human female from the state of isolation in the animal creation in which physiologists are, in general, with regard to this secretion, disposed to place her. It is evident the secretion in the lower animals is as periodic as in her. She has her cycle of time; they each have theirs. Although the cycle of our species may, as the normal standard, be stated to be twenty-eight days, yet there exists so much variety, that each individual woman may be said to have a cycle of her own. It is seldom we meet- with two women who are simultaneously unwell for any number of periods together, and yet,
315 when periodicity is well established in an
82.50 individual, how unerringly, Aqueous particles and 10.90 the re-appearance of the periodic solution its arrival every thirty days; some, 6.58 every 28th; some, every 25th day; and some can depend with Dr. Rainy, Professor of Forensic Medicine in the University confidence on its return every 21st day. One young lady lately of Glasgow, and Dr. Macconechy, analyzed a quantitv of menunder my care had it regularly, for several periods in succession, strual it blood, obtained by puncturing an imperforate every Monday three weeks; another experienced the phenomenon was beginning to get putrid, and evolved ammonia on the addiI for A months together. lady attended tion every third Sunday, Under the microscope, the globules were seen as last year haddischarge every fortnight; each alternate period numerous as in ordinary blood, but their shape was somewhat she looked upon only to be the catamenia; her reason for this as is the case with putrid blood. It was composed ofirregular, opinion was, because it was doubly profuse to the one preceding. 885.5 Water From the facts that have been collected, it would appear that 114.5 Solid residue in passing up through the series of animal beings, the nearer we the more the catamenial ofman, serum was The approach discharge approximates composed in character that of our own species. It would appear, that in Water......................................... 912.8 all it consists of a profuse periodic flow of the usual mucous Solid residue 87.2 secretion of the organs of generation, with, in the higher genera Dr. concluded Hence that blood the consisted ofof animals, the of some more Rainy generally, portion, Serum or less, of blood diffused in the secretion, and from this, its diffu972.2 Globules 27.8 sion, deprived of its usual quantity of coagulation. By some authors, indeed,.the menstrual fluid of women is stated never to ’ No fibrine could be detected. The serum containedcoagulate. This peculiarity, in their opinion, stamps the secreWater 912.8 tion with a character peculiar to it. By other authors, it is, on Albumen....................................... 77.0 the contrary, stated to possess this usual quality of the blood. It Chloride of sodium 6.0 must be familiar to every practitioner in midwifery to have seen Soda 0.2 the secretion sometimes present the one character, sometimes the Animal matter and earthy phosphates... 4.0* other. The disposition to coagulation exists the strongest in those individuals in whom the secretion is the most profuse. At The following is the analysis of Simon, of Berlin. The fluid the present time there is under my examination the menstrual was taken at a time when it contained scarcely any epithelium fluid of a patient in which coagulation is unequivocally demon- scales. It did not coagulate ; it contained some vaginal mucus but it was not putrid, nor of an unpleasant odour. strated. It has been said not to become putrid, and that in cases where, It contained in 1000 partsthe hymen being imperforate, on an operation laying open the Water 785.00 canal to the os uteri, the fluid for years pent up in the vagina 215.00 Solid constituents has indicated no symptom of putridity. In the opinion of some, 2.58 Fat............................................. this has been viewed as an inexplicable phenomenon. But those Albumen 76.54 who consider the non-putridity of this fluid, under such circum120.40 Hæmatoglobulin stances, inexplicable, forget its nature. It is but blood mixed 8.60 Extractive matter with, and rendered thin by mucus. Chemists have discovered in Simon observes, that "the most striking peculiarities of this the secretion the constituent elements of blood; some have detected fibrine in it, whilst others, whose accuracy is unquestion- blood are, the total absence of fibrine, and the increase of the solid able, have been unable to* detect it in the specimens they have constituents caused by the excess of the blood corpuscles. The .subjected to examination.* Microscopic examination leads to the colouring matter amounted to 8.3 per cent. of the hsematoconclusion that it is blood attenuated by the local secretions. Such globulin." The facts that have now been submitted to the reader, as illusbeing the case, it is not remarkable that it should indicate, under such circumstances, no putridity. Blood extravasated in unin- trative of the catamenia in other female mammals besides the female, will have their full weight with the physiologist; jured cellular membrane shews no disposition to putridity. In human and yet, even after all that has been adduced in proof of their it and in the is there deposited, coagulates, simple ecchymosis It is only when the structure identity, there may still exist in his mind the startling objection course of time is re-absorbed. around is injured or unhealthy that it takes on the character of referred to as being that of Müller, and he may, like him, consider the analogies still to be imperfect, inasmuch as, whilst in the putridity. But in the catamenia, the blood is so mixed with the lower animals the period of the catamenia is among them the increased, although natural, glairy mucous secretion of the surfaces of the uterus and vagina, that it remains fluid; and as there period only in which, in general, they admit sexual intercourse, as no disposition in blood itself, when deposited within a healthy it is, on the other hand, the time when woman shuns the society structure, to decay, what is there in mucus to excite putridity? of the male. The experience of society, however, leads to a conWhen do we find the secretion natural to a surface, ever in that clusion the reverse of this opinion of Milller, and the knowledge surface a cause of unhealthy excitement ? The bile pent up in possessed by the observant man of the worid more truly illustrates .the gall bladder becomes inspissated, not putrid. The glairy the matter than the speculations of the philosopher. Were the latsecretion of the salivary glands arrested in the duct, and con- ter to leave his closet, and enter society in search of truth, he would, of the opinion of Müller, soon perceive that he was mistaken; stituting ranula, on puncture, invariably is healthy and trans- if and when his mind had compassed the philosophy of the subject, parent. It ought not, therefore, to be a matter of surprise that the if not a misanthrope, but a lover of his species, he would re-enter natural discharge of the catamenia retained within a sac formed his cabinet with his philanthropy augmented, and more especially his respect for the sex profoundly exalted. Before he reby the healthy mucous membrane of the vagina should remain an with indefinite period uncorrupt and of local disturbance. turned to his privacy, he would be struck with admiration of the It may be well here to add the latest chemical analyses of the influence exercised by moral culture on the feelings and passions of humanity, and he would more especially not fail to observe the human menstrual fluid. marvellous power exercised by civilization§ on the mind of her The following is an analysis by Denis:— who, from her social position, is rendered the charm of man’s Water 82.50 existence. Her social position has rendered woman keenly perFibrine...................................................... 0.05 cipient of every thought or action beautiful or graceful, and her
,generally, can she calculate discharge! Some look for
.....................
InIn suspension
TOTAL
on
in globules......
..............................
hymen:
of potash.
.........................................
.................................
.................................
super-addition,
..........................................
.......................................
..........................................
........................
...........................................
.......................................
.........................
....................................
...........................
and salts ............
unproductive
......................................................
Hæmatosin Alucus
...............................................
......................................................
Albumen................................................... Oxide of iron ............................................ Red
phosphoric,
and traces of white
6.34 4.53 4.83 0.05
phosphoric ?
0.39 greaseof each..................... .....} Osmazome 0.11
and cruorine,
Subearbonate and hydrochlorate of soda, 0.95 hydrochlorate of potash, each .....................) of lime 0.25 and Carbonate, phosphate Traces of phosphate of magnesia.....................
and
..................
-
*
Vide Warwick’s Essay on this subject in the Medical Gazette, March 29, Mr. W. has shown great research in his essay, and has given an analysis of most of the conflicting opinions on this subject. &dag er; No. 333. L’Experience, Rakiborski’s Essay.
1844, p. 863.
*
Thomson’s
Chemistry, p. 375.
&dag er; Anthropochemie. p.
’
234.
monkey is observed receive satirical
Berlin,
Ed. 1843. 1842.
the embrace of the male at all times,. to t The and Aristotle states, that the mare is disposed to sexual intercourse even Dean of St. Patrick was in error after impregnation; so that the when he stated the yahoo to be the on:y animal that would admit the male whilst she was pregnant." § It may be considered that the infiuence of civilization is here too highly rated. But Locke has shewn us how there can be no innate ideas. AU mental phenomena must depend on the senses; all moral, on education. The knowledge of sex itself, may it not rest on educaiioii ? Two years ago, an aggravated case of hypospadia (or hermaphroditism) came under my observation. On account of this peculiarity of arrested development, the young man had been brought up from infancy as a female. All the mental phenomena that were exhibited in this individual were those of the female, not of the male sex. Timidity, gentleness, and bashfulness, existed ia. excess.
316 sensitively on the watch to shut out from contem- and the pains, although occasionally stronger affected the pre’plation everything of an opposite character. Taught from infancy sentation not in the least. The head could not be said to be imto subjugate her passions and affections, her thoughts, her looks, pacted, for in some parts of the circumference of the pelvis, the her language, are kept under control. She simulates health when examining finger could be passed up by the side of it with no ill, ease when in pain, and contentment is expressed by her smile great difficulty. I thus discovered an ear behind the-pubis, and when her heart is torn with agony. Need it be a matter of the position to be that of the face directed to the right ilium. The --wonder, when we see her capable of such self-restraint in patient was getting fatigued, but there was no extraordinary exgeneral, that she should retire within herself, and exercise that citement of the vascular system, no inordinate heat of the genitals, control we find her continually exerting over all her thoughts and consequently no indication for depletive treatment. The case and actions, the more energetically, at a time when she is taught was one of arrest of the head rather than of impaction, and that a stray thought of desire would be impurity, and its fruition nature appeared to have been sparing in her efforts, lest mischief pollution.* To aid her in such a duty, nature has wisely pro- should be done. vided her with the sexual appetite slightly developed.t Considering the difficulty in the case to depend partly upon the In this respect she may be placed in the same category as the position of the head not being the most favourable, and partly females of all other mammals. Man, on the other hand, and the also, in all probability, upon some disproportion between its males of all mammals, must be placed, in respect to sexual desire, dimensions and those of the pelvis, I determined upon the employin a category of their own. In him, as in them, the passion ment of the long forceps, as the preferable mode of treatment exists in a state of exaltation, hurrying him, when uncontrolled, under the circumstances. into a state of degradation, and frequently into crime. It being ascertained that the bladder and the rectum were empty, I carefully introduced and applied the forceps along the sides of (To be continued.) the pelvis, with a little inclination of the respective blades towards the acetabulum on the one hand, and the sacro-iliac junction on the other. Applying traction, and resting alternately, I gradually ON A. NEW REMEDY FOR PSORIASIS. brought the head down past what appeared to me to be the point of difficulty, and at the same time directed the face to the right to JOSHUA the WADDINGTON, Esq. Consulting Surgeon By sacro-iliac junction. Having thus placed the head in a favourable Royal Sea-Bathing Infirmary, Margate. and brought it partly down into the cavity of the pelvis, of as as the WITH the view public rendering possible easy position, I now removed the instruments, preferring that nature should hermeans I have for some time past adopted of speedily subduing a self alone effect its further descent, as also the dilatation of the very common, and, if treated improperly, a very dangerous disin her own best and safest time, and the more especially I THE of the extensive circulation of avail ease, LANCET, perineum, myself as it was a case of first parturition, rather than, by continued efforts of the that in the treatment or to state, psoriasis diffusa, palmaria, of traction, expose that and the other soft structures lining the best application is the ol. palm. cocc. (cocoa-nut oil,) diluted with pelvis to risk of injury. The pains, however, proved not to be should be of The affected cectacei. parts ung. portions equal for this purpose; I therefore recommended washed every night and morning with tepid rain water, then sufficiently propellent the ergot of rye to be given, there being no contra-indication a made quite dry, and the ointment applied lightly, (with of it at the present stage of the case. The malposition camel’s-hair brush;) over this, oiled-silk should constantly be to the use of the head had been corrected; the head had been brought past worn. I need scarcely remark, that pilul. hydr. sub. comp. (Plummer’s the seat of difficulty; there was no heat, nor dryness, nor rigidity of the soft passage; the orifice of the uterus had been dilated long pill,) gr. x., each night at bed-time, with liq. potassæ, m.xx., ago, otherwise I could not have legitimately employed the forthree times a day, are among the best internal means of treating the outlet of the pelvis was at least of average dimensions, ceps ; no with care as psoriasis diffusa, joined great regards regimen: salted meats, no shell-fish, no fermented liquors, no acids; the if not above them. I thus hoped to supersede the further employment of the above instrument. The ordinary quantity less fruit and vegetables the better. After twenty-eight years’ extensive practice at the sea-side, which I employ of the above medicine, that of half a drachm of I venture to add, that warm or cold sea-bathing is not generally the fresh powder, given at intervals of ten and fifteen minutes, in advisable in cases of psoriasis diffusa, and have often been at- infusion, was exhibited for three doses; a brisk action was induced, and with some good effect, for the head further descended tended with dangerous results. At some future period, when professional avocations are fewer into the cavity of the pelvis, and came to bear against the outlet and less pressing, I intend to submit to the public a more par- of the passage; but here it was again arrested, on account, as ticular account, both of my theory and practise, as regards subsequently proved to be the fact, of the child being conThe head, however, had above the average size. psoriasis, and other eruptive complaints, accompanied with a siderably mind is always
descended within the reach of the short forceps, and with a view life, I completed the delivery with that instrument, cautiously and slowly, and with due regard to the safety of the perineum, about six P.M. The child being born in an apoplectic condition, with an extremely turgid face, and incapable of breathing, a table-spoonful CONTRIBUTIONS IN MIDWIFERY. of blood, by measure, was allowed to flow from the divided cord, when the child speedily exhibited signs of By J. HALL DAVIS, M.D., Physician to the Royal Maternity vessels of the and cried. The size of the child was considerably life, breathed, Charity. above the average, its weight being nine pounds and a half. There Difficult Parturition—Delivery by the Forceps-Remarhs on the was a firm hour-glass contraction of the uterus, which being overeffects of Operations with the Forceps, and the Prophylactic come by time and patience, the placenta was removed by the Treatment. hand without any difficulty. There was no haemorrhage. On the following morning we met at eight. Our patient had OCTOBER llth, 1843, at two P.m., I was requested by a meThe slept four or five hours, from the effect of a draught containing dical friend to meet him in a case of difficult labour. patient, the subject of it, was twenty-one years of age, and of thin one grain of morphia. She had passed water without difficulty, habit of body. She had previously enjoyed good health. It was and was free from pain; but, nevertheless, the skin was dry and her first child. The liquor amnii had escaped twelve hours pre- hot, there were thirst, restlessness, a tongue coated with a white viously. Her pains had been of moderate strength and frequency fur, a pulse 90, with some activity about its beat, and not for the first few hours, but latterly they had been weaker, and at readily compressed; a scanty lochial discharge. We therefore of taking blood from the arm. Twenty longer intervals. The orifice of the uterus, my friend informed agreed in the propriety me, had become fully dilated shortly after the discharge of the ounces flowed in a full stream without our patient fainting, waters. I found, on examination, a protrusion of scalp, but the although in a sitting posture. The skin, however, having head itself had not descended in any degree into the pelvic cavity, exchanged its dryness for moisture, and lost its excessive temperature ; and the pulse having softened, the patient, moreover, * In the Rambler, vol. i. No. 39, the sorrow and suffering entailed on expressing herself as feeling cooler and more comfortable, the arm woman from her social position, and borne by her in silence, are elegantly was tied up. The bowels were opened by a dose of castor oil, and feelingly described by Johnson. That original author, Mr. Alexander and a saline diaphoretic, containing tartarized antimony, was given Walker, in his book" °° On Intermarriage," 1838, expresses opinions similar to at intervals. An antiphlogistic regimen was enjoined. On our what 1 have detailed. t The reader may be startled at this proposition; but if he doubts it, he visit on the following day, the blood taken exhibited a strongly is referred to Heywood’s Our patient was going on satisTYNAIKEION," and Alexander’s History of buffed and cupped surface. Women," which teem with examples of this constitutional indifference ; and the pulse was soft, and 80 beats; the skin of natural if still desirous of further proofs of a like character, he is referred to the factorily ; temperature, and moist; and the discharge of lochia had customs of the Hottentots and Kamskatckans, alluded to by Lord Kaimes
I have treated. Marine-terrace, Margate, Nov. 22, 1844.
schedule of the
cases
"
in his
"
Sketches of Man."
to the child’s
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increased.