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UNUSUAL CIRCUMSTANCES AT. TENDING LABOUR.
800 much emaciated from
are not injectible, what proof is afforded that they are tubular?" The argument appears a powerful one, but it may be readily met, and it has, in part, been answered already. However, in continuation, I would allude to the facts that the nerves and the substance of nervous matter is tubular, and yet that we are not able to throw injection beyond the neurilema of a nerve. That bones are porous, or tubular, yet who has succeeded in injecting the internal laminae of the cylindrical bones ? What then is the obstacle ? Doubtless it is the density of the resistingmedium. But should the fact that the shaft of the bone is impervious to injection, be any cause for denying that such channels do exist? Now, the resisting power to the successful injection of the oil tubes is far greater than that in bone, because the osseous resistance may be overcome by chemical agents, but it is otherwise with the dense, cold fat passing into the mouth of the kidney, semicircular oil tubes, &c. Chemistry not having yet furnished us with the agents for destroying fat, we are not yet able to empty the tubes of their natural contents, and to fill them with a foreign and uncongenial liquid,
as
a
long-continued dis.
consumption. My friend, Mr. Solly, has alluded to the absence of any explanation on my part re. specting the vital agent for propelling this oil through the gland, but I have already trespassed too long upon your kindness, and will, therefore, with your permission, continue the subject in another communication, when I shall have the pleasure, if it please the Lord, in whose Almighty hand our life
ease,
as
and breath are, and who says in His unerring Word, "I kill and I make alive,I wound and I heal, and without Me ye can do nothing," to give me health for the same, to discuss the following points in connection with the foregoing remarks. The arrangement of the veins and their porous character within the semicircular oil tubes; the circulation of purified oil through the medium of these veins; the venous origin of the urinary ducts ; the appearance presented to the eye from a diseased condition of these oil tubes ; and, lastly, the identity which ex. ists between the chemical relations of animal fat, urea, and uric acid, &c.
by injection.
It only remains now for me to describe the mode of preparation, as after numerous I UNUSUAL CIRCUMSTANCES AT. TENDING LABOUR. experiments its success was insured. I will suppose the kidney of a sheep, or ox, or human subject, either injected or not at the To the Editor of THE LANCET, pleasure of the operator ; it may be cut in SIR:—The annexed case being, I think, a what form the party chooses, or left entirely one, I forward it for inservery perfect. The reflected membrane, either tion inuncommon useful Periodical. Yours very your off or left that on, stripped only observing in the latter case it requires a longer period truly. HORATIO COLLMAN, M.R.C.S., &c. than in the former, the immersed gland or 41, Old Broad-street, Feb. 8th, 1840. slice should be in a vessel of clean water, covering the vessel over, and the gland left A lady, about eight months advanced in entirely untouched, for at least ten days, a fortnight, or three weeks, or more, according her pregnancy, was, without any previous to the age, sex, toughness of the organ, &c. pain, or any evident cause, taken, on the When the water is putrid, the hand should night of Nov. 23, 1839, with haemorrhage be plunged carefully into Ihe vessel, to which continued for a few hours, though knead off genUy the decomposed parts, not profuse, and then ceased entirely on the which will easily drop away as a sediment following morning. She was up and about to the bottom. Having done this, the nu- as usual again until Nov. 29th, when the cleus should be shaken and cleansed in hæmorrhage returned more in quantity than different clean waters. Towards the latter before, and was increased by her turning or end of this process various masses of the i moving herself, but still, though copious, it harder portions (the medullary) will be was not violent. Slight painsnow came on, felt clinging to the delicate oil tubes, and as and, after each pain had ceased, some haethese portions are carefully drawn off under morrhage occurred ; after this had gone on clean water, the adjunction of the oil tubes for some hours, the pains as well as the with the urinary ducts will be beautifully haemorrhage again went off. On the followdisplayed. The success of the whole pro- I ing night regular labour came on, the pre’ cess depends, mainly, upon the complete sentation was natural, and, after a very bad putrefaction of all the soft parts. The same and lingering time, she was confined with a process is applicable to, and has succeeded stillborn child. At the birth, or afterwards, in, the liver and spleen of several fish, and there was scacely any discharge; the funis was flat, broad, very thick, and literally mammalia. The tubes in the nucleus of the kidney of white;on dividing it, not one drop of blood an ox are not so perceptibly tubular as are exuded; and, on removing the placenta,which the tubes in the nucleus of the kidney of the almost immediately followed the birth, this human subject, where the body has become also (the placenta) was almost white, and no
I
I
801 The patient went
blood exuded from it. on in the hope that the body might be ejected, favourably, afterwards, without anything but without avail. Finding the substance unusual occurring. Now, the placenta fixed just above the opening, the author must in this case have been entirely sepa- extracted it with a pair of forceps, and rated from the uterus previous to the birth, found it to be a portion of one of the cervical and yet there was no flooding during or after vertebrae of a sheep, nearly half an inch labour. Was not this extraordinary ? Why long. The voice was perfectly restored was there not haemorrhage during the labour in about two hours, and the patient rebefore the contraction of the uterus on the covered. In the records of 70 or 80 cases examined expulsion of its contents (the placenta being detached)? by the author, he has been able to find only P.S. The patient had felt the movement one presenting similar symptoms to those of the infant distinctly on the day before which characterised the case now related. her confinement.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
Tuesday, February 11th,
Case in which Tracheotomy was performed for the Removal (!f a Foreign Body in the Air Passages. By BENJAMIN TRAVERS, Esq., Jun. Communicated by BENJAMIN TRAVERS,
Esq., F.R.S., &c. &c.
1840.
A child, about six years of age, while seated on the ground, eating cherries, was Sir B. C. BRODIE, Bart., President. thrown backwards, and immediRemarks on the Diagnosis of Foreign Bodies suddenly diately seized with a violent fit of choking, in the Larynx. By CÆSAR HAWKINS, Esq., and every symptom of impending suffocaSurgeon to St. George’s Hospital. tion, a condition which is said to have lasted THE author remarks that many of the re- a full hour. This accident was followed by corded cases of this kind have terminated spasmodic pain in the chest, dyspnoea, and fatally from chronic inflammation, in conse- other symptoms of acute inflammation ; but quence of the operation for the removal of the cough ceased so entirely for a considerthe foreign bodies not having been performed able time, that the surgeon in attendance for many weeks, or even months, after their concluded that the offending body had accidental introduction, and that the delay passed down the oesophagus, and not into the in those instances has probably arisen from air-tube. The symptoms, however, recurring the difficulty in their diagnosis. He is in- with great violence, Mr. Travers was called duced to offer the present case to the atten- to see the patient, and at his first visit, two tion of the Society, from its not having been or three weeks after the accident, found the marked by any of the signs which are set breathing stridulous and laboured, the pulse down by authors as those on which most small and hurried, the countenance suffused confidence should be placed in forming a and anxious; there were frequent paroxysms diagnosis. For example, the difficulty of of croupy cough, with much consequent breathing was unremitting, no noise could exhaustion. The author opened the tracheal be heard by the striking of the substance tube, between the isthmus of the thyroid against the vocal chords, the feverish ex- i gland and the top of the sternum,to the immecitement w as considerable, there was abso- diate relief of the patient’s breathing; and the lutely no cough whatever after the first few cough did not return again for some days. seconds, and instead of the noise in breath- Before leaving the patient the author passed ing being chiefly on inspiration it was heard a silver catheter upwards through the larynx, on the day of the accident only in respiration, with a view of ascertaing that the tube was and on the following day it was equally not obstructed in that direction. Six or audible in both portions of the respiratory seven weeks after the operation the wound process. The case is, briefly, as follows :- was allowed to heal, when the cough shortly A young lady, 12 years of age, was suddenly reappeared, with night-sweats and loss of seized, while taking some soup, with violent appetite. About a mouth after the closure vomiting and suffocating cough, which of the wound the cherry-stone, which had lasted for a short time, and then left her passed into the tube, was ejected during a with a noise in breathing, and a fixed pain violent fit of coughing, accompanied by a beneath the cricoid cartilage. small quantity of pus. The relation of the When the author saw her she was breath- case is followed by some observations upon ing without labour, but with a croupy souad, the phenomena presented by it, and several and complained of tenderness, referred others previously recorded in the "Transacchiefly to the cricoid cartilage. She could tions" of the Society, and elsewhere. swallow without difficulty. On the day Dr. WEBSTER had several years since after the accident, as the symptoms continued unabated, an opening was made inmet with a very interesting case, similar to the trachea below the thyroid gland, andthose related to the Society, and having, in the patient was desired to cough repeatedly, consequence, given considerable attention to
,
are not injectible, what proof is afforded that they are tubular?" The argument appears a powerful one, but it may be readily met, and it has, in part, been answered already. However, in continuation, I would allude to the facts that the nerves and the substance of nervous matter is tubular, and yet that we are not able to throw injection beyond the neurilema of a nerve. That bones are porous, or tubular, yet who has succeeded in injecting the internal laminae of the cylindrical bones ? What then is the obstacle ? Doubtless it is the density of the resistingmedium. But should the fact that the shaft of the bone is impervious to injection, be any cause for denying that such channels do exist? Now, the resisting power to the successful injection of the oil tubes is far greater than that in bone, because the osseous resistance may be overcome by chemical agents, but it is otherwise with the dense, cold fat passing into the mouth of the kidney, semicircular oil tubes, &c. Chemistry not having yet furnished us with the agents for destroying fat, we are not yet able to empty the tubes of their natural contents, and to fill them with a foreign and uncongenial liquid,
as
a
long-continued dis.
consumption. My friend, Mr. Solly, has alluded to the absence of any explanation on my part re. specting the vital agent for propelling this oil through the gland, but I have already trespassed too long upon your kindness, and will, therefore, with your permission, continue the subject in another communication, when I shall have the pleasure, if it please the Lord, in whose Almighty hand our life
ease,
as
and breath are, and who says in His unerring Word, "I kill and I make alive,I wound and I heal, and without Me ye can do nothing," to give me health for the same, to discuss the following points in connection with the foregoing remarks. The arrangement of the veins and their porous character within the semicircular oil tubes; the circulation of purified oil through the medium of these veins; the venous origin of the urinary ducts ; the appearance presented to the eye from a diseased condition of these oil tubes ; and, lastly, the identity which ex. ists between the chemical relations of animal fat, urea, and uric acid, &c.
by injection.
It only remains now for me to describe the mode of preparation, as after numerous I UNUSUAL CIRCUMSTANCES AT. TENDING LABOUR. experiments its success was insured. I will suppose the kidney of a sheep, or ox, or human subject, either injected or not at the To the Editor of THE LANCET, pleasure of the operator ; it may be cut in SIR:—The annexed case being, I think, a what form the party chooses, or left entirely one, I forward it for inservery perfect. The reflected membrane, either tion inuncommon useful Periodical. Yours very your off or left that on, stripped only observing in the latter case it requires a longer period truly. HORATIO COLLMAN, M.R.C.S., &c. than in the former, the immersed gland or 41, Old Broad-street, Feb. 8th, 1840. slice should be in a vessel of clean water, covering the vessel over, and the gland left A lady, about eight months advanced in entirely untouched, for at least ten days, a fortnight, or three weeks, or more, according her pregnancy, was, without any previous to the age, sex, toughness of the organ, &c. pain, or any evident cause, taken, on the When the water is putrid, the hand should night of Nov. 23, 1839, with haemorrhage be plunged carefully into Ihe vessel, to which continued for a few hours, though knead off genUy the decomposed parts, not profuse, and then ceased entirely on the which will easily drop away as a sediment following morning. She was up and about to the bottom. Having done this, the nu- as usual again until Nov. 29th, when the cleus should be shaken and cleansed in hæmorrhage returned more in quantity than different clean waters. Towards the latter before, and was increased by her turning or end of this process various masses of the i moving herself, but still, though copious, it harder portions (the medullary) will be was not violent. Slight painsnow came on, felt clinging to the delicate oil tubes, and as and, after each pain had ceased, some haethese portions are carefully drawn off under morrhage occurred ; after this had gone on clean water, the adjunction of the oil tubes for some hours, the pains as well as the with the urinary ducts will be beautifully haemorrhage again went off. On the followdisplayed. The success of the whole pro- I ing night regular labour came on, the pre’ cess depends, mainly, upon the complete sentation was natural, and, after a very bad putrefaction of all the soft parts. The same and lingering time, she was confined with a process is applicable to, and has succeeded stillborn child. At the birth, or afterwards, in, the liver and spleen of several fish, and there was scacely any discharge; the funis was flat, broad, very thick, and literally mammalia. The tubes in the nucleus of the kidney of white;on dividing it, not one drop of blood an ox are not so perceptibly tubular as are exuded; and, on removing the placenta,which the tubes in the nucleus of the kidney of the almost immediately followed the birth, this human subject, where the body has become also (the placenta) was almost white, and no
I
I
801 The patient went
blood exuded from it. on in the hope that the body might be ejected, favourably, afterwards, without anything but without avail. Finding the substance unusual occurring. Now, the placenta fixed just above the opening, the author must in this case have been entirely sepa- extracted it with a pair of forceps, and rated from the uterus previous to the birth, found it to be a portion of one of the cervical and yet there was no flooding during or after vertebrae of a sheep, nearly half an inch labour. Was not this extraordinary ? Why long. The voice was perfectly restored was there not haemorrhage during the labour in about two hours, and the patient rebefore the contraction of the uterus on the covered. In the records of 70 or 80 cases examined expulsion of its contents (the placenta being detached)? by the author, he has been able to find only P.S. The patient had felt the movement one presenting similar symptoms to those of the infant distinctly on the day before which characterised the case now related. her confinement.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
Tuesday, February 11th,
Case in which Tracheotomy was performed for the Removal (!f a Foreign Body in the Air Passages. By BENJAMIN TRAVERS, Esq., Jun. Communicated by BENJAMIN TRAVERS,
Esq., F.R.S., &c. &c.
1840.
A child, about six years of age, while seated on the ground, eating cherries, was Sir B. C. BRODIE, Bart., President. thrown backwards, and immediRemarks on the Diagnosis of Foreign Bodies suddenly diately seized with a violent fit of choking, in the Larynx. By CÆSAR HAWKINS, Esq., and every symptom of impending suffocaSurgeon to St. George’s Hospital. tion, a condition which is said to have lasted THE author remarks that many of the re- a full hour. This accident was followed by corded cases of this kind have terminated spasmodic pain in the chest, dyspnoea, and fatally from chronic inflammation, in conse- other symptoms of acute inflammation ; but quence of the operation for the removal of the cough ceased so entirely for a considerthe foreign bodies not having been performed able time, that the surgeon in attendance for many weeks, or even months, after their concluded that the offending body had accidental introduction, and that the delay passed down the oesophagus, and not into the in those instances has probably arisen from air-tube. The symptoms, however, recurring the difficulty in their diagnosis. He is in- with great violence, Mr. Travers was called duced to offer the present case to the atten- to see the patient, and at his first visit, two tion of the Society, from its not having been or three weeks after the accident, found the marked by any of the signs which are set breathing stridulous and laboured, the pulse down by authors as those on which most small and hurried, the countenance suffused confidence should be placed in forming a and anxious; there were frequent paroxysms diagnosis. For example, the difficulty of of croupy cough, with much consequent breathing was unremitting, no noise could exhaustion. The author opened the tracheal be heard by the striking of the substance tube, between the isthmus of the thyroid against the vocal chords, the feverish ex- i gland and the top of the sternum,to the immecitement w as considerable, there was abso- diate relief of the patient’s breathing; and the lutely no cough whatever after the first few cough did not return again for some days. seconds, and instead of the noise in breath- Before leaving the patient the author passed ing being chiefly on inspiration it was heard a silver catheter upwards through the larynx, on the day of the accident only in respiration, with a view of ascertaing that the tube was and on the following day it was equally not obstructed in that direction. Six or audible in both portions of the respiratory seven weeks after the operation the wound process. The case is, briefly, as follows :- was allowed to heal, when the cough shortly A young lady, 12 years of age, was suddenly reappeared, with night-sweats and loss of seized, while taking some soup, with violent appetite. About a mouth after the closure vomiting and suffocating cough, which of the wound the cherry-stone, which had lasted for a short time, and then left her passed into the tube, was ejected during a with a noise in breathing, and a fixed pain violent fit of coughing, accompanied by a beneath the cricoid cartilage. small quantity of pus. The relation of the When the author saw her she was breath- case is followed by some observations upon ing without labour, but with a croupy souad, the phenomena presented by it, and several and complained of tenderness, referred others previously recorded in the "Transacchiefly to the cricoid cartilage. She could tions" of the Society, and elsewhere. swallow without difficulty. On the day Dr. WEBSTER had several years since after the accident, as the symptoms continued unabated, an opening was made inmet with a very interesting case, similar to the trachea below the thyroid gland, andthose related to the Society, and having, in the patient was desired to cough repeatedly, consequence, given considerable attention to
,