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WEST LONDON HOSPITAL.
39
grain of the acetate of morphia. injected subcutaneously into the arm. After the operation the patient progressed favonrably, and left the hospital on April 26th. Mr. Lawson made the following clinical iemarks on the above case :-Nothing is more strange than the etiology of In one patient there is a long past history of the discancer. ease ; it has descended through many generations, and it has become regarded as an heirloom which will fall at some time from chloroform, one third of a
Medical Societies.
was
OBSTETRICAL SOCIETY OF LONDON.
WEDNESDAY, D
R.
O
L D
MAY 4TH, 1864. P R ES I D E
H A M,
N T.
another to the lot of one of the members of the family. That THE following gentlemen were elected Fellows of the the disease is very hereditary is beyond all doubt : the expe- Society :-Mr. E. Des Forges (South Cave, Yorkshire), Mr. rience of the past and the present has established it as a fact. Hartley, Dr. G. Hasenfeld (Pesth, Hungary), and Dr. Wharton How strange, then, is it to find a healthy woman, well nourished P. Hood (Lower Seymour-street). Dr. BARNES exhibited a small Fibroid Tumour of the Uterus yet not over fat, who has always enjoyed good health, whose family is healthy, and whose ancestors have lived to a great spontaneously expelled from a patient who had suffered from age and died apparently from natural decay, suddenly become metrorrhagia. the victim of this terrible complaint. Such, however, is the Dr. GREENHALGH communicated the result of the case of history of many cases; and the cancer wards of this hospital amputation of the cervix uteri mentioned at the last meeting. furnish frequently such examples of the first outbreak of cancer The patient died some days after the operation, of peritonitis. in a family. The patients in whom the disease thus originates Dr. BARNES, remarking on this case, observed that Dr. Marion Sims’ method of removing the cervix uteri was superior are usually those in whom it might have been least expected. Up to the period of their present illness, their history very to the operation by the ecraseur, the surface left denuded being commonly has been one of uninterrupted good health. The smaller, and the risk of peritonitis probably less. Dr. FUSSELL, of Brighton, exhibited a specimen, consisting cause of the origin of cancer is still hidden; yet we may hope that a continued and careful study of the many cases which are of the uterus of a patient who had died five days after removal always under observation and treatment in the wards of the of a cancerous tumour from the cervix uteri. The interior of hospital will, in time, disclose important facts relative to this the uterus was found diseased, and there were also fibroid disease. In the case now recorded there is one striking fea- tumours in the uterine parietes. Dr. ROUTH stated, in the course of a discussion which arose ture : in the patient’s family there is no history whatever of cancer. Her father and mother were long-lived : the one died on the merits of different ecraseurs, that he had found by exat seventy-nine, and the other at eighty one years of age. Her periment that the wire-rope écraseur cut through the tissue of sisters and brothers are also healthy; and she herself-now the cow’s uterus more readily than the chain ecraseur. Dr. GRAILY HEWITT exhibited an entire ovum of seven forty-nine years of age, married twenty-three years, and the .mother of three children-enjoyed, up to quite a recent period, months’ development which had been forwarded to him by the most perfect health. The disease in this patient, thougb Dr. Whitmarsh, of Hounslow. The ovum had been expelled apparently of short duration, had made rapid progress. It ten days after symptoms of labour had set in. probably commenced first as a lobular scirrhus -that is to ON THE APPLICATION OF EXTREME COI,D AS AN ANODYNE IN say, a small, hard tumour at the lower margin of the breast, THE PAIN ATTENDANT ON PARTURITION. but with a slight connexion with one of its lower lobes, The BY J. MORTIMER GRANVILL, L.R.C.F. LOND., ETC., BRISTOL. mammary gland it is likely next became invaded with the dis. An examination of the phenomena of labour, more especially ease; for, after making a section of it, we found, in addition to the primary tumour, that the whole gland was infiltrated in relation to the nature, duration, and intensity of the pain with carcinomatous deposit. The disease had advanced intc accompanying it, has led the author to the following conclnits second stage; superficially, the skin was puckered and ad sions :-1st. The actual pain (as distinguished from the sensaherent to the tumour; whilst deeply, it had already contractec tion of forcing) experienced by the parturient woman bears no a small adhesion to the pectoral muscle. The glands in th definite proportion to the force and efficiency of what (for want axilla, as far as could be ascertained, were as yet unaffected b3 of a better name) we term the pains" of her labour. 2nd. The sensation of pain is not invariably synchronous with the occurthe disease. rence of uterine contraction, the effects of the latter being perWEST LONDON HOSPITAL. ceptible to the accoucheur not unfrequently, during examination, before his patient experiences the former. INGUINAL HERNIA TREATED BY WOOD’S OPERATION ; CURE. From these circumstances, taken in connexion with others well known to careful observers, it may be inferred, that the (Under the care of Mr. TEEVAN.) attendant on labour is more directly related to the effects E. J-, a stout boy, aged ten, was admitted an in patient pain of uterine contraction (perhaps mechanical force operating on on May 3rd, 1864, with an inguinal rupture on the left side, nervous tissue) than to the specific muscular act itself. about the size of a walnut, and extending into the scrotum. No The reference of the pain to some region more or less remote the contracting uterus or the dilating external passages previous history of the case could be ascertained, as the lad, a fromwhich the seat of pain might have been supposed to be destitute and friendless orphan, had not been long at the (in to support the last inference; whilst it clearly located) appears "Refuge," the manager of which institution was very anxious points to the conclusion, that the pain attendant on labour is that something should be done to cure the child’s rupture. neuralgic in its character. On May 4tb, Mr. Teevan returned the hernia, and introduced Acting on this theory, the author has tried the effect of Mr. Wood’s rectangular pins. A large mass of lymph was extreme cold as a topical anodyne, and the result has been so thrown out into the canal, and some slight suppuration followed constant that, after repeated experiment, he feels confidence in around the pin holes ; but there was no constitutional disturb- bringing this new method of seeking to alleviate the pains of ance, nor any tenderness over the abdomen. The pins were labour before the Society, and suggesting its adoption by the taken out on the twelfth day from their introduction, and on profession. The method is applicable in all casps, independent June 1st, as the apertures were quite healed, and the canal of the condition of the patient,-cold being already in use as a apparently firmly consolidated, the boy was ordered to get out powerful means of exciting the uterus to contraction in cases of of bed and walk across the ward, to spe if there was any ten- extreme exhaustion. It is perfectly free from the dangers so dency to a return of the protrusion. Not the slightest appear- inseparable from the most cautious use of anaesthetics. It is ance of the gut could be detected, and accordingly on the folperfectly manageable, and may be safely confided to a nurse; lowing day he was discharged, wearing a truss, with orders to and its rationale is in strict conformity with the well-known continue the same for six months. principles of physiology. It is not intended to remove, but to Mr. Teevan remarked that, before undertaking the above alleviate, the pain attendant on parturition. It will be found operation, the surgeon should always ascertain whether both that the power of the uterine efforts is generally increased, testes had descended. In this case only one testis had come! without any corresponding increase in the attendant suffering, down; but fortunately, as might have been expected, it was the patient being not unfrequently under the impression that the one on the ruptured side. Previously to commencing the the pain has ceased when the presentation continues to evidence operation, he desired his colleague, Mr. Bird, to hold the testis ;; the continuance of the expulsive force. 1 his has been very refor if this were not done, it was very likely to be pushed ucI in some of the cases-the pains appearing to be into the canal by the invaginating finger-an accident which shortened, when examination has proved them to be prolonged. The actual pain is sensibly diminished, the patients expressing he believed had occurred more thaek once. or
.
markable
grain of the acetate of morphia. injected subcutaneously into the arm. After the operation the patient progressed favonrably, and left the hospital on April 26th. Mr. Lawson made the following clinical iemarks on the above case :-Nothing is more strange than the etiology of In one patient there is a long past history of the discancer. ease ; it has descended through many generations, and it has become regarded as an heirloom which will fall at some time from chloroform, one third of a
Medical Societies.
was
OBSTETRICAL SOCIETY OF LONDON.
WEDNESDAY, D
R.
O
L D
MAY 4TH, 1864. P R ES I D E
H A M,
N T.
another to the lot of one of the members of the family. That THE following gentlemen were elected Fellows of the the disease is very hereditary is beyond all doubt : the expe- Society :-Mr. E. Des Forges (South Cave, Yorkshire), Mr. rience of the past and the present has established it as a fact. Hartley, Dr. G. Hasenfeld (Pesth, Hungary), and Dr. Wharton How strange, then, is it to find a healthy woman, well nourished P. Hood (Lower Seymour-street). Dr. BARNES exhibited a small Fibroid Tumour of the Uterus yet not over fat, who has always enjoyed good health, whose family is healthy, and whose ancestors have lived to a great spontaneously expelled from a patient who had suffered from age and died apparently from natural decay, suddenly become metrorrhagia. the victim of this terrible complaint. Such, however, is the Dr. GREENHALGH communicated the result of the case of history of many cases; and the cancer wards of this hospital amputation of the cervix uteri mentioned at the last meeting. furnish frequently such examples of the first outbreak of cancer The patient died some days after the operation, of peritonitis. in a family. The patients in whom the disease thus originates Dr. BARNES, remarking on this case, observed that Dr. Marion Sims’ method of removing the cervix uteri was superior are usually those in whom it might have been least expected. Up to the period of their present illness, their history very to the operation by the ecraseur, the surface left denuded being commonly has been one of uninterrupted good health. The smaller, and the risk of peritonitis probably less. Dr. FUSSELL, of Brighton, exhibited a specimen, consisting cause of the origin of cancer is still hidden; yet we may hope that a continued and careful study of the many cases which are of the uterus of a patient who had died five days after removal always under observation and treatment in the wards of the of a cancerous tumour from the cervix uteri. The interior of hospital will, in time, disclose important facts relative to this the uterus was found diseased, and there were also fibroid disease. In the case now recorded there is one striking fea- tumours in the uterine parietes. Dr. ROUTH stated, in the course of a discussion which arose ture : in the patient’s family there is no history whatever of cancer. Her father and mother were long-lived : the one died on the merits of different ecraseurs, that he had found by exat seventy-nine, and the other at eighty one years of age. Her periment that the wire-rope écraseur cut through the tissue of sisters and brothers are also healthy; and she herself-now the cow’s uterus more readily than the chain ecraseur. Dr. GRAILY HEWITT exhibited an entire ovum of seven forty-nine years of age, married twenty-three years, and the .mother of three children-enjoyed, up to quite a recent period, months’ development which had been forwarded to him by the most perfect health. The disease in this patient, thougb Dr. Whitmarsh, of Hounslow. The ovum had been expelled apparently of short duration, had made rapid progress. It ten days after symptoms of labour had set in. probably commenced first as a lobular scirrhus -that is to ON THE APPLICATION OF EXTREME COI,D AS AN ANODYNE IN say, a small, hard tumour at the lower margin of the breast, THE PAIN ATTENDANT ON PARTURITION. but with a slight connexion with one of its lower lobes, The BY J. MORTIMER GRANVILL, L.R.C.F. LOND., ETC., BRISTOL. mammary gland it is likely next became invaded with the dis. An examination of the phenomena of labour, more especially ease; for, after making a section of it, we found, in addition to the primary tumour, that the whole gland was infiltrated in relation to the nature, duration, and intensity of the pain with carcinomatous deposit. The disease had advanced intc accompanying it, has led the author to the following conclnits second stage; superficially, the skin was puckered and ad sions :-1st. The actual pain (as distinguished from the sensaherent to the tumour; whilst deeply, it had already contractec tion of forcing) experienced by the parturient woman bears no a small adhesion to the pectoral muscle. The glands in th definite proportion to the force and efficiency of what (for want axilla, as far as could be ascertained, were as yet unaffected b3 of a better name) we term the pains" of her labour. 2nd. The sensation of pain is not invariably synchronous with the occurthe disease. rence of uterine contraction, the effects of the latter being perWEST LONDON HOSPITAL. ceptible to the accoucheur not unfrequently, during examination, before his patient experiences the former. INGUINAL HERNIA TREATED BY WOOD’S OPERATION ; CURE. From these circumstances, taken in connexion with others well known to careful observers, it may be inferred, that the (Under the care of Mr. TEEVAN.) attendant on labour is more directly related to the effects E. J-, a stout boy, aged ten, was admitted an in patient pain of uterine contraction (perhaps mechanical force operating on on May 3rd, 1864, with an inguinal rupture on the left side, nervous tissue) than to the specific muscular act itself. about the size of a walnut, and extending into the scrotum. No The reference of the pain to some region more or less remote the contracting uterus or the dilating external passages previous history of the case could be ascertained, as the lad, a fromwhich the seat of pain might have been supposed to be destitute and friendless orphan, had not been long at the (in to support the last inference; whilst it clearly located) appears "Refuge," the manager of which institution was very anxious points to the conclusion, that the pain attendant on labour is that something should be done to cure the child’s rupture. neuralgic in its character. On May 4tb, Mr. Teevan returned the hernia, and introduced Acting on this theory, the author has tried the effect of Mr. Wood’s rectangular pins. A large mass of lymph was extreme cold as a topical anodyne, and the result has been so thrown out into the canal, and some slight suppuration followed constant that, after repeated experiment, he feels confidence in around the pin holes ; but there was no constitutional disturb- bringing this new method of seeking to alleviate the pains of ance, nor any tenderness over the abdomen. The pins were labour before the Society, and suggesting its adoption by the taken out on the twelfth day from their introduction, and on profession. The method is applicable in all casps, independent June 1st, as the apertures were quite healed, and the canal of the condition of the patient,-cold being already in use as a apparently firmly consolidated, the boy was ordered to get out powerful means of exciting the uterus to contraction in cases of of bed and walk across the ward, to spe if there was any ten- extreme exhaustion. It is perfectly free from the dangers so dency to a return of the protrusion. Not the slightest appear- inseparable from the most cautious use of anaesthetics. It is ance of the gut could be detected, and accordingly on the folperfectly manageable, and may be safely confided to a nurse; lowing day he was discharged, wearing a truss, with orders to and its rationale is in strict conformity with the well-known continue the same for six months. principles of physiology. It is not intended to remove, but to Mr. Teevan remarked that, before undertaking the above alleviate, the pain attendant on parturition. It will be found operation, the surgeon should always ascertain whether both that the power of the uterine efforts is generally increased, testes had descended. In this case only one testis had come! without any corresponding increase in the attendant suffering, down; but fortunately, as might have been expected, it was the patient being not unfrequently under the impression that the one on the ruptured side. Previously to commencing the the pain has ceased when the presentation continues to evidence operation, he desired his colleague, Mr. Bird, to hold the testis ;; the continuance of the expulsive force. 1 his has been very refor if this were not done, it was very likely to be pushed ucI in some of the cases-the pains appearing to be into the canal by the invaginating finger-an accident which shortened, when examination has proved them to be prolonged. The actual pain is sensibly diminished, the patients expressing he believed had occurred more thaek once. or
.
markable