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PARTICULARS OF A CASE OF CÆSAREAN OPERATION.
203
I
PARTICULARS OF A
CASE
OF
CÆSAREAN
BY ROBT.
OPERATION.
GREENHALGH, M.D.,
PHYSICIAN-ACCOUCHEUR TO ST. BARTHOLOMEW’S LECTURER ON MIDWIFERY, ETC.
HOSPITAL,
dance of healthy urine voided." Dr. Hall concludes: "I think there is every prospect of the patient’s recovery from the operation."" Grosvenor-street, August 22nd, lS66.
REMARKS ON
THE MRS. W-, aged twenty-nine, married two years, conthe 12th of of on Dr. sulted Hall, Brighton, September, 1865," for a discharge from the rectum of " slimy and bloody matter," BY T. G. TEBAY, M.D. accompanied with a sensation of bearing down, not amounting to actual pain. These symptoms commenced nearly a yearr I HAD intended to forward a few remarks on cholera for the before marriage, since which the catamenia have been frequentt and profuse. On examination per vaginam, Dr. Hall detected1 pages of THE LANCET, when Dr. Painter’s excellent paper As colleagues, with a population of came under my notice. j a hard growth in the recto-vaginal fossa, extending upwards ; sixty thousand to a great extent under our official charge. I some inches ; and on examining per rectum, this enlargement would add my testimony to his against the dangerous character was found to surround the bowel, which it considerably obstructed. Dr. Hall had no doubt about the carcinomatousi of the " eliminative theory." I consider that, when once nature of the tumour, for which he treated her up to the 6thL serous diarrhoea has set in, every hour is of importance to of November, when she was so much improved in health as tot enable the practitioner to check a discharge that is rapidly be able to undertake a journey to Ireland. sapping the vital powers and destroying the normal chemistry On the 3rd of last March she again applied to Dr. Hall on of the vital fluid. I found the ordinary vegetable astringents, with chalk and account of her catamenia being absent for three successive! very valuable in the early diarrhoea, aided by the remonths, who, after a careful investigation, pronounced her to, opium, cumbent position, to which I attach much importance. Vegebe about four months pregnant, and advised, as the growth table I fell back with excellent effect upon had considerably increased and was still increasing, the induc- lead astringents failing, (opium cautiously administered) and acetic acid, the lead tion of abortion. and opium in pill when the vomiting was troublesome. The Again Dr. Hall lost sight of her until the llth of August, ordinary effervescing mixture of soda and tartaric acid, with when he heard from Dr. Fuller, of Shoreham, that she had not slight excess of alkali and from three to five minims of tincture been delivered. Fearing that great difficulties might arise of opium, was found invaluable in many cases for arresting during labour, he visited the patient on the 16th instant in the distressing vomiting that so materially interfered with the company with Dr. Fuller, when they both came to the con- administration of food and remedies. The cholera belt, a broad flannel bandage swathing the clusion that, owing to the limited space in the pelvis, she could not be delivered by any other means than the Csesarean opera- abdomen comfortably tight, assisted in preventing relapse. tion. I was then requested to see the patient, and, if neces- This remedy was strongly recommended to me by Dr. King, Inspector-General of Naval Hospitals. sary, to perform the operation. Accordingly, on the 18th R.N., I advocate the free use, in small quantities, of water filtered instant I carefully investigated the case, and fully confirmed the diagnosis of her medical attendants-that the tumour was and afterwards boiled, to which ice may be added when thirst solid and immovable, that in no part of the pelvis could more is troublesome. The wet sheet certainly appeared often useful than the index-finger be passed, and that the cervix and os in bringing on reaction, but I do not believe it to be of the uteri could not be reached,-which opinion was subsequently great service that some writers would indicate. In the numerous class of cases ushered in by colicky pains, confirmed by Drs. Meadows, Murray, and others. The serious nature of the case, and the means proposed for vomiting, and diarrhoea, I commenced with a full dose of relief, being fairly represented to the patient and her friends, calomel and opium-a grain of opium with four grains of calomel,-giving half the dose in three or four hours afterpermission was granted to do what was necessary. As she was within three weeks of the full period, and the wards if the symptoms were not relieved, followed by astrinchild was alive and vigorous, it was deemed inexpedient to gents without delay. A few doses of calomel appeared useful delay. Accordingly, in the presence of Drs. Sieveking, Murray, with the view of preventing the bad effect of opium in blockand Dawson, Mr. J. Murray, Mr. Philpot, and others, and ing the biliary ducts, and promoting the secretion of bile assisted by Drs. Hall, Fuller, Richardson, and Meadows, and when absent in the excreta. Turpentine stupes were in conMr. Arnold, I proceeded to perform the operation. All prepara- stant use. I may add that my experience is drawn from battling with tions being completed, and the patient being placed upon a table with her head somewhat raised, Dr. Richardson rapidly anees- the epidemics of 1849 and 1854, on both of which occasions thetised the abdominal parietes with the ether spray, when I Westminster was severely visited. Aided by good assistants, made an incision, between four and five inches in length, be- in 1849,I treated about 3000 cases, having only the use of half neath the umbilicus and through the abdominal parietes, fol- a small hospital of eighteen beds. In 1854, during four months, lowed by another through the uterus, which enabled me to intro- unaided that year by a cholera hospital, my share was about duce my hand and seize the right thigh of the child, by which 4000 cases (3800 registered rame and address), including 700 cases of cholera, of which number 70 died. delivery was immediately effected. I quite agree with Dr. Painter as to the cautious adminisIt is worthy of remark, that the time occupied from the first incision to the extraction of a living female child was tration of brandy in the disease, and avoidance of opium in about forty seconds, and from the birth to the removal of the the least approach to collapse. In conclusion I will add an extract from Dr. Aitken’s placenta fifty seconds. There was but a small quantity of liquor amnii, and the placenta, which was small, was attached "Practice of Medicine,"in which he quotes (p. 634, vol. i.) to the right side and anterior surface of the uterus. Less than Schmidt of Dorpat:six ounces of blood was lost. "The water transudes before the solids of the serum; the Pressure was kept up for some time upon the uterus until inorganic before the organic solids; the chlorides before the firm contraction was secured, when the abdominal wound was phosphates ; the salts of soda before the salts of potash ; and closed by eleven interrupted silk sutures, supported by five it is interesting to observe that the order is very much the broad strips of adhesive plaster, over which were placed pads same as takes place during the action of some purgative mediof lint, the whole being secured by a many-tailed bandage. cine, such as elaterium. Very soon after this transudation of On removal to bed, the pulse and general aspect of the patient some of the constituents of the serum commences, an important were scarcely affected. She complained of slight smarting, change occurs in the blood : the normal diffusion currents and expressed herself as most grateful. between its fluid part and the fluid in the blood-cells alter ; Aug. 21st, four P.M. (fifty-four hours after the operation).- and the constituents of the blood-cells transude into the serum, Dr. Hall reports: " Slight pains, like after-pains; pulse 100, in the same order as the constituents of the serum transude soft and regular; tongue moist, and fairly clean ; the counte- .into the alimentary canal-that is to say, the water diffuses nance free from anxiety; healthy vaginal discharge; abun-I more readily than the solids; the inorganic solids more readily CHOLERA TREATMENT AND ELIMINATIVE THEORY. -
.
,
-
I
I
PARTICULARS OF A
CASE
OF
CÆSAREAN
BY ROBT.
OPERATION.
GREENHALGH, M.D.,
PHYSICIAN-ACCOUCHEUR TO ST. BARTHOLOMEW’S LECTURER ON MIDWIFERY, ETC.
HOSPITAL,
dance of healthy urine voided." Dr. Hall concludes: "I think there is every prospect of the patient’s recovery from the operation."" Grosvenor-street, August 22nd, lS66.
REMARKS ON
THE MRS. W-, aged twenty-nine, married two years, conthe 12th of of on Dr. sulted Hall, Brighton, September, 1865," for a discharge from the rectum of " slimy and bloody matter," BY T. G. TEBAY, M.D. accompanied with a sensation of bearing down, not amounting to actual pain. These symptoms commenced nearly a yearr I HAD intended to forward a few remarks on cholera for the before marriage, since which the catamenia have been frequentt and profuse. On examination per vaginam, Dr. Hall detected1 pages of THE LANCET, when Dr. Painter’s excellent paper As colleagues, with a population of came under my notice. j a hard growth in the recto-vaginal fossa, extending upwards ; sixty thousand to a great extent under our official charge. I some inches ; and on examining per rectum, this enlargement would add my testimony to his against the dangerous character was found to surround the bowel, which it considerably obstructed. Dr. Hall had no doubt about the carcinomatousi of the " eliminative theory." I consider that, when once nature of the tumour, for which he treated her up to the 6thL serous diarrhoea has set in, every hour is of importance to of November, when she was so much improved in health as tot enable the practitioner to check a discharge that is rapidly be able to undertake a journey to Ireland. sapping the vital powers and destroying the normal chemistry On the 3rd of last March she again applied to Dr. Hall on of the vital fluid. I found the ordinary vegetable astringents, with chalk and account of her catamenia being absent for three successive! very valuable in the early diarrhoea, aided by the remonths, who, after a careful investigation, pronounced her to, opium, cumbent position, to which I attach much importance. Vegebe about four months pregnant, and advised, as the growth table I fell back with excellent effect upon had considerably increased and was still increasing, the induc- lead astringents failing, (opium cautiously administered) and acetic acid, the lead tion of abortion. and opium in pill when the vomiting was troublesome. The Again Dr. Hall lost sight of her until the llth of August, ordinary effervescing mixture of soda and tartaric acid, with when he heard from Dr. Fuller, of Shoreham, that she had not slight excess of alkali and from three to five minims of tincture been delivered. Fearing that great difficulties might arise of opium, was found invaluable in many cases for arresting during labour, he visited the patient on the 16th instant in the distressing vomiting that so materially interfered with the company with Dr. Fuller, when they both came to the con- administration of food and remedies. The cholera belt, a broad flannel bandage swathing the clusion that, owing to the limited space in the pelvis, she could not be delivered by any other means than the Csesarean opera- abdomen comfortably tight, assisted in preventing relapse. tion. I was then requested to see the patient, and, if neces- This remedy was strongly recommended to me by Dr. King, Inspector-General of Naval Hospitals. sary, to perform the operation. Accordingly, on the 18th R.N., I advocate the free use, in small quantities, of water filtered instant I carefully investigated the case, and fully confirmed the diagnosis of her medical attendants-that the tumour was and afterwards boiled, to which ice may be added when thirst solid and immovable, that in no part of the pelvis could more is troublesome. The wet sheet certainly appeared often useful than the index-finger be passed, and that the cervix and os in bringing on reaction, but I do not believe it to be of the uteri could not be reached,-which opinion was subsequently great service that some writers would indicate. In the numerous class of cases ushered in by colicky pains, confirmed by Drs. Meadows, Murray, and others. The serious nature of the case, and the means proposed for vomiting, and diarrhoea, I commenced with a full dose of relief, being fairly represented to the patient and her friends, calomel and opium-a grain of opium with four grains of calomel,-giving half the dose in three or four hours afterpermission was granted to do what was necessary. As she was within three weeks of the full period, and the wards if the symptoms were not relieved, followed by astrinchild was alive and vigorous, it was deemed inexpedient to gents without delay. A few doses of calomel appeared useful delay. Accordingly, in the presence of Drs. Sieveking, Murray, with the view of preventing the bad effect of opium in blockand Dawson, Mr. J. Murray, Mr. Philpot, and others, and ing the biliary ducts, and promoting the secretion of bile assisted by Drs. Hall, Fuller, Richardson, and Meadows, and when absent in the excreta. Turpentine stupes were in conMr. Arnold, I proceeded to perform the operation. All prepara- stant use. I may add that my experience is drawn from battling with tions being completed, and the patient being placed upon a table with her head somewhat raised, Dr. Richardson rapidly anees- the epidemics of 1849 and 1854, on both of which occasions thetised the abdominal parietes with the ether spray, when I Westminster was severely visited. Aided by good assistants, made an incision, between four and five inches in length, be- in 1849,I treated about 3000 cases, having only the use of half neath the umbilicus and through the abdominal parietes, fol- a small hospital of eighteen beds. In 1854, during four months, lowed by another through the uterus, which enabled me to intro- unaided that year by a cholera hospital, my share was about duce my hand and seize the right thigh of the child, by which 4000 cases (3800 registered rame and address), including 700 cases of cholera, of which number 70 died. delivery was immediately effected. I quite agree with Dr. Painter as to the cautious adminisIt is worthy of remark, that the time occupied from the first incision to the extraction of a living female child was tration of brandy in the disease, and avoidance of opium in about forty seconds, and from the birth to the removal of the the least approach to collapse. In conclusion I will add an extract from Dr. Aitken’s placenta fifty seconds. There was but a small quantity of liquor amnii, and the placenta, which was small, was attached "Practice of Medicine,"in which he quotes (p. 634, vol. i.) to the right side and anterior surface of the uterus. Less than Schmidt of Dorpat:six ounces of blood was lost. "The water transudes before the solids of the serum; the Pressure was kept up for some time upon the uterus until inorganic before the organic solids; the chlorides before the firm contraction was secured, when the abdominal wound was phosphates ; the salts of soda before the salts of potash ; and closed by eleven interrupted silk sutures, supported by five it is interesting to observe that the order is very much the broad strips of adhesive plaster, over which were placed pads same as takes place during the action of some purgative mediof lint, the whole being secured by a many-tailed bandage. cine, such as elaterium. Very soon after this transudation of On removal to bed, the pulse and general aspect of the patient some of the constituents of the serum commences, an important were scarcely affected. She complained of slight smarting, change occurs in the blood : the normal diffusion currents and expressed herself as most grateful. between its fluid part and the fluid in the blood-cells alter ; Aug. 21st, four P.M. (fifty-four hours after the operation).- and the constituents of the blood-cells transude into the serum, Dr. Hall reports: " Slight pains, like after-pains; pulse 100, in the same order as the constituents of the serum transude soft and regular; tongue moist, and fairly clean ; the counte- .into the alimentary canal-that is to say, the water diffuses nance free from anxiety; healthy vaginal discharge; abun-I more readily than the solids; the inorganic solids more readily CHOLERA TREATMENT AND ELIMINATIVE THEORY. -
.
,
-
I