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WESTERN MEDICAL AND SURGICAL SOCIETY.
alluded to the absence of pain in hysterical patients, when the attention of the sufferer was directed to another object, when pressure was made over the affected joint. Dr. CAMPS considered that a difference between neuralgia and hysteria was sufficiently marked. In the first, the symptoms were dependent upon a morbid condition of the nerves of the part; in the second, they arose from the brain. In the first, there might be heat and redness; in the second, these symptoms were generally absent. Dr. WJLLSHIRE observed, that when heat and swelling were present in cases of hysteria, there was something in addition to the hysterical condition present. Neuralgia was of excentric origin. It might be dependent upon inflammation of the nerve or its covering, or the irritation of a spicula of bone, or other local causes. Hysteria was developed from centric causes. Dr. HEADLAXD ridiculed the performance of an operation, or the introduction of a seton, in hysteria, as means calculated still further to direct the patient’s attention to the part affected. The treatment must be mainly directed to the constitutional condition of the patient. Mr. WEEDEN CooK recommended the use of friction and cold affusion in hysterical joints, and thought that operations were
justifiable. DUNN, jun., considered that heat and swelling were not symptoms of hysteria, but of neuralgia, and related an instance to show the effect of mental impressions upon the production of hysterical symptoms.
not
Mr.
Dr. OGIER WARD mentioned an instance recorded in the "Life of Sir H. Davy," illustrative of the power of the mind in curing disease. A man affected with paralysis, in the course of experiments, had a thermometer placed under his tongue on several successive occasions, and was eventually cured. Mr. BARWELL having replied, the Society adjourned.
WESTERN MEDICAL AND SURGICAL SOCIETY.
FRIDAY, OCTOBER 22ND, 1858. A. B. BARNES, ESQ., PRESIDENT,
IN THE
CHAIR.
AFTER the transaction of the ordinary routine business, the PRESIDENT opened the session by making a few introductory remarks upon the objects and advantages of the Society. He then passed on to the different medical subjects of the day, alluding especially to the Medical Act, which has so lately become the law of the land. He considered that much good might
come from it, if the profession proved true to itself, tenacious of its own rights and honour. He called upon the profession to prove itself an united body, and not to offer to the public the disreputable aspect of being divided into numerous parties, each jealous of the other, and offering opposition to each other’s movements, all of which, if properly directed, should have but oae object in view-namely, the common weal of the community at large. After remarking upon the necessity there was for every member of the profession to act from the highest motives, he observed that the opinion the public formed of us entirely depended upon ourselves and our actions, and as such was the case, he thought that we should support one another in all difficulties, and on all occasions when no contrary principle was involved. The present efficient state of the library was then passed in review, and its increasing value extolled as a great boon to the members of the Society. It numbered several hundred volumes, all of which were available for home use. The late Warrant for the Army Medical Service was then alluded to, and its appearance hailed as a great boon, and as hut a just rewardin appreciation of the services of the medical officers ; this justice, though late, was very welcome, and tended to make them in no way inferior to that of the combatant portion of the army in the estimation of the public.
eventually and
was
dreaming, only more profound." Passing from the psychoof the subject, he alluded to the more practical application of it, and recognised the various states and circumstances of the system in which the symptom is likely to occur, and specialized that occurring in insanity and in delirium tremens. The symptoms accompanying its occurrence were briefly alluded to, and each state of brain, where the blood is in excess or in deficiency, received its share of attention. The convulsions, or muscular movements, too, which were often present, were discussed, especially as they tended, by their continuance, to exhaust the vital energy of the patient.
of
logy
Delirium was classified as of two kinds. 1. Where it deupon, and was associated with, increased or decreased vascular action only. In these cases the symptom will, of course, vary according to the state of the brain, as regards the quantity of blood circulating in it. If congestion be present, the whole system will be in a state of muscular and nervous exaltation, and the delirium probably very violent and maniacal; on the contrary, in the other state of the system it will be associated with an exhausted state of nervous and vital energy. 2. Where it is dependent upon, and associated with, some toxic element circulating in the blood, as occurs during the progress of typhus, and all fevers of the specific kind. In these cases the toxaemia was the fo?zs et origo naali, and recognising that fact, our endeavours must regard the general system rather than the symptom. How the poison in the blood acts, whether by directly exciting the brain-matter to action, or by exciting some molecular change in the nerve vesicles, it was impossible to state; we were only able to recognise the symptom as due to this poison, and therefore were called upon to rally the system while under its influence. The principles of treatment and the morbid appearances were briefly sketched, and much attention was drawn to the fact of the false, or pseudo morbid signs often seen after death, which appearances were often due to post-mortem changes in the vessels, and often depended, not upon inflammatory action during life, but upon the mode of dying, or upon some organic change taking place immediately after death. The occurrence of delirium in typhus was then especially entered upon, and its nature discussed. It was regarded as due to the blood-poisoning in the majority of cases, though in a few, even in fever, it might be caused by an inflammatory condition of the brain and its membranes. The difficulty of recognising its true cause was alluded to, and Dr. Graves’ admirable observations on this subject mentioned. What is the true action of the fever poison on the brain-matter ? The answer involved in this question was too extensive to receive more than a general notice. It might be that several elements were at work to produce the one prominent result; it might be that the poison effected some alteration in the relations between certain parts of the brain, or by its actual presence acted as an irritant to the nervous matter, exciting in it increased action in certain parts, and exercising a paralysing effect on other controlling portions; or, perhaps, the poison might so far alter the physical character of the blood as to render it more or less incapable of flowing freely through the capillaries. All these speculations open out yet more extensive fields of inquiry, em-
pended
oraclng, as they ao, me normal race or eircuiauion necessary for healthy action of the brain; the degree of arterialization which is essential for the same, and how far it is interfered with in these cases, and the part which the retention of carbonic acid in the blood (all the vital functions, especially respiration, being lowered) takes in the development of the delirium. Leaving the speculativepart of the subject, the application of remedies next called for attention, and the general subject of wine and opium entered upon, the objects to be borne in mind being to support the strength during the continuance of the fever, and to calm the restless action of the nervous system. In pericarditis the occurrence of delirium was an important event, inasmuch as it often suddenly set in, and betokened much danger. Post-mortem appearances, and general careful observation during life have recognised this symptom to be deDr. BAINES then read a paper, pendent upon a deficient supply of blood to the brain, and to ON DELIRIUM, ESPECIALLY IN ITS RELATION TO FEVER be indicative of exhaustion in a large majority of cases; in AND PERICARDITIS. three,quoted by Dr. Watson, it was found in connexion with of inflammatory action in the brain. It geneCommencing with a few introductory remarks respecting the unequivocal in rheumatic occurs and the of delirium, rally pericarditis; though, out of sixteen clearly defining placing difficulty boundary line between it and rational action of the mind, he sketched cases quoted by Dr. Burrows, there was evidence of rheumatism also during endocarditis, the chief mental phenomena which are generally observable in only in seven. It may be which circumstance may afford a link to the probable explacases where the mind becomes aberrant, stating that the regulating power of the reason was absent in all cases of delirium, nation offered of its dependence upon a deficient or irregular of blood to the brain, caused by weakened or oppressed and that the ideas in the mind ran together in confusion and unconnectedness. He drew an analogy between it and dream- heart-action. Is that, then, its only possible explanation ? Meing, adopting Dr. Pritchard’s idea, that delirium ’’is a species I tastasis in a very few cases may possibly be the cause, as seems
signs
developed
supply
528
established by Dr. Fife, of Newcastle, Dr. Burrows, and Dr* ventilation is maintained, that even at the time patients are Fuller; still it seldom happens. Dr. Bright considered tha being delivered there is almost a perfect absence of puerperal irritation of the phrenic nerve might probably be a cause, by odour; while visitations of puerperal fever are very rare, and the inflammatory action passing to the exterior of the periof trismus amongst the infants exceedingly uncommon. cardium; but after-observations do not confirm this opinion. cases A poisoned state of the blood must be recognised, and may help It is an important fact, that whereas, before the present plan to develop the symptom, as in typhus and scarlatina. If we of ventilation was introduced by the late Dr. Joseph Clarke, recognise the delirium as dependent upon debiiity of the brain, the mortality amongst the infants averaged 1 in every 4½of from deficient supply of blood, or from the lessened amount of those born alive, it has since fallen to 1 in 24. It need only pressure which, in health, seems essential for its proper exer- be further noticed that the patients are not generally admitted cise, as has been proved by the experiments of Dr. Burrows, the principles of treatment are sufficiently clear. Stimulants until labour has commenced, or until there are symptoms indi-
approach; and that they are discharged, if sufficiently well, on the eighth day from their delivery. It is rather curious, that, as a rule, great difficulty is experienced in prevailing upon the women to remain until the eighth day, numbers of them insisting upon being discharged before the ordinary time. The husbands are allowed to visit their wives every day after the third from delivery, at all times, up to a reasonable hour; but it has been found necessary to exclude all Practical Midwifery; comprising an account of 13,748 female which occurred in the friends, Dublin owing to the ill effects which frequently arose veries, Lying-in Hospital during a period of seven years, commencing November, from their injudicious conversation ! 1847. By EDWARD B. SINCLAIR, B.A., ex-Assistant-PhyThe volume before us gives an account of the cases of labour sician to the Dublin Lying-in Hospital ; and GEORGE which occurred in the hospital from November, 1847, to the JOHNSTON, M.D., &c. &c. 8vo, pp. 574. London : John same month in 1854; during which seven years Dr. Shekleton Churchill. was the master. In this time 13,748 women were delivered, THIS imposing-looking volume is a simple clinical record, or and gave birth to 13,933 children; not including fifty abortions statistical account, of all the deliveries which took place in the which occurred at so early a period as to render it impossible Dublin Lying.in Hospital during the time that the authors, Of the 13,933 children, 7177 were to distinguish the sex. separately or conjointly, occupied the position of assistant- males, and 6i 56 females; while the still-born, including those physicians. In addition to giving the results of the practice, born putrid, amounted to 968. Of the 13,748 women delivered, these gentlemen have also laid down the principles which re4535 were 233 had twins; one had triplets; and gulated the treatment of each particular class of labour when 163 died inprimiparons; from all causes, puerperal and other. childbirth, it differed from that ordinarily laid down in our modern textOf this latter number, however, 17 were admitted in a dying books ; whilst the history of most of the important cases is also state; so that, deducting these, as may fairly be done, there recorded. It would, of course, be impossible to analyze for any Part of this mortality-70 0 were 146 fatal cases, or 1 in 94. useful purpose such a work as this in any critical notice of cases-was due to puerperal epidemics. If we arrange the moderate length ; since, to derive instruction from its pages, it months in gradation according to the greatest number of delimust be studied as a whole. We shall therefore merely make veries in each, they will run as follows:-May, March, June, a few remarks on the institution where the volume was comApril, July, August, February, November, December, Septempiled, and conclude by giving a summary account of the results ber, October, January; while to show the greatest amount of which have been obtained. mortality their order must be almost reversed, since although We learn from the Introduction, that prior to the year 1745 theMay series during the seven years afforded the largest number there was no maternity charity in Dublin; but that in the of deliveries, yet it presented the smallest number of deaths ; March of that year one was founded by Dr. Bartholomew Moss, while December, with almost the least number of labours, had and worked " solely at his own risk." Three years afterwards the greatest amount of mortality. the benefits of this hospital were so highly appreciated by the From the foregoing it will be perceived that Drs. Johnston poor of the city, that the accommodation was found insufficient and Sinclair have had no small field for close observation; and to meet the demands for admission; and accordingly Dr. Moss done in have undoubtedly they very wisely presenting the began to take steps for the erection of the present magnificent results of their experience to the profession. V’could have building. It was not, however, until nearly the end of the wished that this treatise had been given to us in a less bulky year 1757 that its worthy founder succeeded in opening its form, and with many of its chapters written in a more condoors for the admission of patients ; for this gentleman had to densed style; but, at the same time, we are bound to add that encounter much jealous opposition and many difficulties. From we could point to dozens of volumes on medical subjects, this period (1757) until the end of the year 1847 there have having equal pretensions so far as size and appearance go, yet been delivered within its walls 156,100 women, who have given with infinitely less real merit to excuse their magnitude. birth to 158, 35 children; 2366 of the women delivered having had twins, 33 tr’plets, and only 1 quadruplets. Of the 156,100 cative of its
and opium should be our sheet-anchors while we combat the local inflammation by local bleedings, blisters, and calomel.
Reviews and Notices of Books.
Del,i-I
,
delivered, 1903 died in childbed. Of the total number of children born-viz., 158,535, there were 82,314 males, and 76,221 females. Of the entire number of children born, 9291 were dead-born, 5733 died in hospital, and 143,511 went out alive. From this it appears that nearly I child in every 172 was still-born, while 1 out of every 26 born alive died in hospital ; it is also apparent that nearly 1 woman in every 66 had twins, and 1 in 4730 triplets. The mortality of the women delivered from all causes was 1 in 82. At the present time the hospital supports only 103 beds, though it is capable of containing 140. The bels are diffused over eleven wards, nine of which are used in their turn for the reception of cases of labour, one as a convalescent room, and the other for patients labouring under disease of the sexual organs. Through these apartments such a perfect system of
women
foreign Department. LAEYNGEAL OPERATIONS IN PARIS.
to be the order of the
day, and methods of a proposed by various surgeons. We have already alluded to ill. Bonchut, who leaves for several days a dilating canula in the larynx, (THE LAXCE’r, p. 364.) The same operator now proposes to forestall the distressing symptoms of croup by removing the tonsils at the outset of the disease. Cases in support are brought forward. On the first of these operations M. Trousseau has just reported, and eloquently shows that the intra-laryngeal permanent dilatation is very difficult of application, uncertain in its results, and far inferior to tracheotomy. The latter operation is shown, when THESE
seem
strange kind
are
early performed,
to be much less fatal than has
529
been supposed.
justifiable. DUNN, jun., considered that heat and swelling were not symptoms of hysteria, but of neuralgia, and related an instance to show the effect of mental impressions upon the production of hysterical symptoms.
not
Mr.
Dr. OGIER WARD mentioned an instance recorded in the "Life of Sir H. Davy," illustrative of the power of the mind in curing disease. A man affected with paralysis, in the course of experiments, had a thermometer placed under his tongue on several successive occasions, and was eventually cured. Mr. BARWELL having replied, the Society adjourned.
WESTERN MEDICAL AND SURGICAL SOCIETY.
FRIDAY, OCTOBER 22ND, 1858. A. B. BARNES, ESQ., PRESIDENT,
IN THE
CHAIR.
AFTER the transaction of the ordinary routine business, the PRESIDENT opened the session by making a few introductory remarks upon the objects and advantages of the Society. He then passed on to the different medical subjects of the day, alluding especially to the Medical Act, which has so lately become the law of the land. He considered that much good might
come from it, if the profession proved true to itself, tenacious of its own rights and honour. He called upon the profession to prove itself an united body, and not to offer to the public the disreputable aspect of being divided into numerous parties, each jealous of the other, and offering opposition to each other’s movements, all of which, if properly directed, should have but oae object in view-namely, the common weal of the community at large. After remarking upon the necessity there was for every member of the profession to act from the highest motives, he observed that the opinion the public formed of us entirely depended upon ourselves and our actions, and as such was the case, he thought that we should support one another in all difficulties, and on all occasions when no contrary principle was involved. The present efficient state of the library was then passed in review, and its increasing value extolled as a great boon to the members of the Society. It numbered several hundred volumes, all of which were available for home use. The late Warrant for the Army Medical Service was then alluded to, and its appearance hailed as a great boon, and as hut a just rewardin appreciation of the services of the medical officers ; this justice, though late, was very welcome, and tended to make them in no way inferior to that of the combatant portion of the army in the estimation of the public.
eventually and
was
dreaming, only more profound." Passing from the psychoof the subject, he alluded to the more practical application of it, and recognised the various states and circumstances of the system in which the symptom is likely to occur, and specialized that occurring in insanity and in delirium tremens. The symptoms accompanying its occurrence were briefly alluded to, and each state of brain, where the blood is in excess or in deficiency, received its share of attention. The convulsions, or muscular movements, too, which were often present, were discussed, especially as they tended, by their continuance, to exhaust the vital energy of the patient.
of
logy
Delirium was classified as of two kinds. 1. Where it deupon, and was associated with, increased or decreased vascular action only. In these cases the symptom will, of course, vary according to the state of the brain, as regards the quantity of blood circulating in it. If congestion be present, the whole system will be in a state of muscular and nervous exaltation, and the delirium probably very violent and maniacal; on the contrary, in the other state of the system it will be associated with an exhausted state of nervous and vital energy. 2. Where it is dependent upon, and associated with, some toxic element circulating in the blood, as occurs during the progress of typhus, and all fevers of the specific kind. In these cases the toxaemia was the fo?zs et origo naali, and recognising that fact, our endeavours must regard the general system rather than the symptom. How the poison in the blood acts, whether by directly exciting the brain-matter to action, or by exciting some molecular change in the nerve vesicles, it was impossible to state; we were only able to recognise the symptom as due to this poison, and therefore were called upon to rally the system while under its influence. The principles of treatment and the morbid appearances were briefly sketched, and much attention was drawn to the fact of the false, or pseudo morbid signs often seen after death, which appearances were often due to post-mortem changes in the vessels, and often depended, not upon inflammatory action during life, but upon the mode of dying, or upon some organic change taking place immediately after death. The occurrence of delirium in typhus was then especially entered upon, and its nature discussed. It was regarded as due to the blood-poisoning in the majority of cases, though in a few, even in fever, it might be caused by an inflammatory condition of the brain and its membranes. The difficulty of recognising its true cause was alluded to, and Dr. Graves’ admirable observations on this subject mentioned. What is the true action of the fever poison on the brain-matter ? The answer involved in this question was too extensive to receive more than a general notice. It might be that several elements were at work to produce the one prominent result; it might be that the poison effected some alteration in the relations between certain parts of the brain, or by its actual presence acted as an irritant to the nervous matter, exciting in it increased action in certain parts, and exercising a paralysing effect on other controlling portions; or, perhaps, the poison might so far alter the physical character of the blood as to render it more or less incapable of flowing freely through the capillaries. All these speculations open out yet more extensive fields of inquiry, em-
pended
oraclng, as they ao, me normal race or eircuiauion necessary for healthy action of the brain; the degree of arterialization which is essential for the same, and how far it is interfered with in these cases, and the part which the retention of carbonic acid in the blood (all the vital functions, especially respiration, being lowered) takes in the development of the delirium. Leaving the speculativepart of the subject, the application of remedies next called for attention, and the general subject of wine and opium entered upon, the objects to be borne in mind being to support the strength during the continuance of the fever, and to calm the restless action of the nervous system. In pericarditis the occurrence of delirium was an important event, inasmuch as it often suddenly set in, and betokened much danger. Post-mortem appearances, and general careful observation during life have recognised this symptom to be deDr. BAINES then read a paper, pendent upon a deficient supply of blood to the brain, and to ON DELIRIUM, ESPECIALLY IN ITS RELATION TO FEVER be indicative of exhaustion in a large majority of cases; in AND PERICARDITIS. three,quoted by Dr. Watson, it was found in connexion with of inflammatory action in the brain. It geneCommencing with a few introductory remarks respecting the unequivocal in rheumatic occurs and the of delirium, rally pericarditis; though, out of sixteen clearly defining placing difficulty boundary line between it and rational action of the mind, he sketched cases quoted by Dr. Burrows, there was evidence of rheumatism also during endocarditis, the chief mental phenomena which are generally observable in only in seven. It may be which circumstance may afford a link to the probable explacases where the mind becomes aberrant, stating that the regulating power of the reason was absent in all cases of delirium, nation offered of its dependence upon a deficient or irregular of blood to the brain, caused by weakened or oppressed and that the ideas in the mind ran together in confusion and unconnectedness. He drew an analogy between it and dream- heart-action. Is that, then, its only possible explanation ? Meing, adopting Dr. Pritchard’s idea, that delirium ’’is a species I tastasis in a very few cases may possibly be the cause, as seems
signs
developed
supply
528
established by Dr. Fife, of Newcastle, Dr. Burrows, and Dr* ventilation is maintained, that even at the time patients are Fuller; still it seldom happens. Dr. Bright considered tha being delivered there is almost a perfect absence of puerperal irritation of the phrenic nerve might probably be a cause, by odour; while visitations of puerperal fever are very rare, and the inflammatory action passing to the exterior of the periof trismus amongst the infants exceedingly uncommon. cardium; but after-observations do not confirm this opinion. cases A poisoned state of the blood must be recognised, and may help It is an important fact, that whereas, before the present plan to develop the symptom, as in typhus and scarlatina. If we of ventilation was introduced by the late Dr. Joseph Clarke, recognise the delirium as dependent upon debiiity of the brain, the mortality amongst the infants averaged 1 in every 4½of from deficient supply of blood, or from the lessened amount of those born alive, it has since fallen to 1 in 24. It need only pressure which, in health, seems essential for its proper exer- be further noticed that the patients are not generally admitted cise, as has been proved by the experiments of Dr. Burrows, the principles of treatment are sufficiently clear. Stimulants until labour has commenced, or until there are symptoms indi-
approach; and that they are discharged, if sufficiently well, on the eighth day from their delivery. It is rather curious, that, as a rule, great difficulty is experienced in prevailing upon the women to remain until the eighth day, numbers of them insisting upon being discharged before the ordinary time. The husbands are allowed to visit their wives every day after the third from delivery, at all times, up to a reasonable hour; but it has been found necessary to exclude all Practical Midwifery; comprising an account of 13,748 female which occurred in the friends, Dublin owing to the ill effects which frequently arose veries, Lying-in Hospital during a period of seven years, commencing November, from their injudicious conversation ! 1847. By EDWARD B. SINCLAIR, B.A., ex-Assistant-PhyThe volume before us gives an account of the cases of labour sician to the Dublin Lying-in Hospital ; and GEORGE which occurred in the hospital from November, 1847, to the JOHNSTON, M.D., &c. &c. 8vo, pp. 574. London : John same month in 1854; during which seven years Dr. Shekleton Churchill. was the master. In this time 13,748 women were delivered, THIS imposing-looking volume is a simple clinical record, or and gave birth to 13,933 children; not including fifty abortions statistical account, of all the deliveries which took place in the which occurred at so early a period as to render it impossible Dublin Lying.in Hospital during the time that the authors, Of the 13,933 children, 7177 were to distinguish the sex. separately or conjointly, occupied the position of assistant- males, and 6i 56 females; while the still-born, including those physicians. In addition to giving the results of the practice, born putrid, amounted to 968. Of the 13,748 women delivered, these gentlemen have also laid down the principles which re4535 were 233 had twins; one had triplets; and gulated the treatment of each particular class of labour when 163 died inprimiparons; from all causes, puerperal and other. childbirth, it differed from that ordinarily laid down in our modern textOf this latter number, however, 17 were admitted in a dying books ; whilst the history of most of the important cases is also state; so that, deducting these, as may fairly be done, there recorded. It would, of course, be impossible to analyze for any Part of this mortality-70 0 were 146 fatal cases, or 1 in 94. useful purpose such a work as this in any critical notice of cases-was due to puerperal epidemics. If we arrange the moderate length ; since, to derive instruction from its pages, it months in gradation according to the greatest number of delimust be studied as a whole. We shall therefore merely make veries in each, they will run as follows:-May, March, June, a few remarks on the institution where the volume was comApril, July, August, February, November, December, Septempiled, and conclude by giving a summary account of the results ber, October, January; while to show the greatest amount of which have been obtained. mortality their order must be almost reversed, since although We learn from the Introduction, that prior to the year 1745 theMay series during the seven years afforded the largest number there was no maternity charity in Dublin; but that in the of deliveries, yet it presented the smallest number of deaths ; March of that year one was founded by Dr. Bartholomew Moss, while December, with almost the least number of labours, had and worked " solely at his own risk." Three years afterwards the greatest amount of mortality. the benefits of this hospital were so highly appreciated by the From the foregoing it will be perceived that Drs. Johnston poor of the city, that the accommodation was found insufficient and Sinclair have had no small field for close observation; and to meet the demands for admission; and accordingly Dr. Moss done in have undoubtedly they very wisely presenting the began to take steps for the erection of the present magnificent results of their experience to the profession. V’could have building. It was not, however, until nearly the end of the wished that this treatise had been given to us in a less bulky year 1757 that its worthy founder succeeded in opening its form, and with many of its chapters written in a more condoors for the admission of patients ; for this gentleman had to densed style; but, at the same time, we are bound to add that encounter much jealous opposition and many difficulties. From we could point to dozens of volumes on medical subjects, this period (1757) until the end of the year 1847 there have having equal pretensions so far as size and appearance go, yet been delivered within its walls 156,100 women, who have given with infinitely less real merit to excuse their magnitude. birth to 158, 35 children; 2366 of the women delivered having had twins, 33 tr’plets, and only 1 quadruplets. Of the 156,100 cative of its
and opium should be our sheet-anchors while we combat the local inflammation by local bleedings, blisters, and calomel.
Reviews and Notices of Books.
Del,i-I
,
delivered, 1903 died in childbed. Of the total number of children born-viz., 158,535, there were 82,314 males, and 76,221 females. Of the entire number of children born, 9291 were dead-born, 5733 died in hospital, and 143,511 went out alive. From this it appears that nearly I child in every 172 was still-born, while 1 out of every 26 born alive died in hospital ; it is also apparent that nearly 1 woman in every 66 had twins, and 1 in 4730 triplets. The mortality of the women delivered from all causes was 1 in 82. At the present time the hospital supports only 103 beds, though it is capable of containing 140. The bels are diffused over eleven wards, nine of which are used in their turn for the reception of cases of labour, one as a convalescent room, and the other for patients labouring under disease of the sexual organs. Through these apartments such a perfect system of
women
foreign Department. LAEYNGEAL OPERATIONS IN PARIS.
to be the order of the
day, and methods of a proposed by various surgeons. We have already alluded to ill. Bonchut, who leaves for several days a dilating canula in the larynx, (THE LAXCE’r, p. 364.) The same operator now proposes to forestall the distressing symptoms of croup by removing the tonsils at the outset of the disease. Cases in support are brought forward. On the first of these operations M. Trousseau has just reported, and eloquently shows that the intra-laryngeal permanent dilatation is very difficult of application, uncertain in its results, and far inferior to tracheotomy. The latter operation is shown, when THESE
seem
strange kind
are
early performed,
to be much less fatal than has
529
been supposed.