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WESTMINSTER MEDICAL SOCIETY.
313 SATURDAY, MARCH Mr. GREENHALGH read
a
11..
paper on
the scrotum, the enlarged-and prominent epididymis is readily felt.
The testis usually seated in front-said to be usually so, because in two instances M. Marchal has found it placed posteriorly-retains its characteristic softness, and if it be compressed, the epididymis being left untouched, the patient complains of no pain; but the contrary occurs if the lastnamed part be meddled with. It is only possible to confound
PLACENTA PRÆVIA.
The
production gave a very good account of our knowledge be pursued in this important devia--
respecting the practice to
tion- from natural labour.- The author did not claim any
originality in his views, and was quite successful in the object he had in view in bringing the subject before the Society, which was, the eliciting the views of the members on this questio vexata. We cannot say, however, that, the debate contained anything more original than the paper. The speakers were Dr. Murphy, Dr. Snow, and Mr. Harding. Dr. REID said, there is a period which has not been adverted to during the evening, and yet it is a most important one, and one which, from the uncertainty attending it, causes the greatest anxiety in the mind of the practitioner. I allude to the eighth or ninth month of pregnancy, when copious hæmorrhage occurs repeatedly, exhausting the patient, and threatenmg destruction on its next recurrence, and yet where no signs of labour have as yet appeared. A practice I have of late followed in such cases is to evacuate the liquor amnii, pass a conically-shaped plug into the os uteri, filling up the vagina behind it, and then to exhibit one or more doses of secale corautum internally. The good effect of this practice, in the few cases in which I have tried it, will induce me to employ it also. for the future. It does not altogether stop the hoemorrhage, of course, but it keepsit for a time within the uterus, where it forms a large coagulum, the presence of which, combined with the irritation caused by the plug, excites uterine contraction, (at this time so anxiously desired.) The os uteri becomes soon much more dilated by the expulsion of the clot, and we are then enabled to introduce the hand and turn the fcetus with more facility; or in some instances the latter, together with the placenta, are speedily expelled. An illiistration of this fact will be found in the following case: On Jan. 28th, I was requested to see a case, with Messrs. Beaman and Wakefield. The lady was advanced to the eighth month of pregnancy, this being her ninth child borne within ten years. She had been seized, during the evening, suddenly with flooding, and, from the effect produced on the system, she must have lost much blood, but there were no uterine contractions. The os uteri just admitted the end of the finger, and the head of the fostus could be felt high up, with a. loose flap of the placenta at.the posterior part. As the flooding continued, it was. determined, at seven P.M., to evacuate the liquor amnii, which was effected by the long trocar generally employed for that purpose, and the plug was inserted in the way described. One drachm of ergot was to be administered likewise. Mr. Beaman, whose patient the lady was, remained in charge of the case, and at half-past nine requested that I should again see it with him,.as the haemorrhage had slightly returned. Mr. Beaman, on making an examination, had found the plug thrust down, with large clots in the vagina, and a considerable re-collection of liquor amnii in a bag of membranes, which were again ruptured. The ergot had been given, and on examining per vaginam, the os uteri was somewhat dilated, with the vertex close to it. In making this last examination I attempted to dilate the aperture, and a labour-pain immediately came on. Four or five more followed in rapid succession, when a fcatus, about seven and a half months advanced, which had evidently been dead for a day or two, was expelled, and the placenta_was extracted by Mr. Beaman immediately after. No haemorrhage recurred, and the lady, although much exhausted by the previous loss of blood, recovered very favourably. The whole labour I should think did not occupy more than half an hour. The same means I have applied with equal advantage in cases of severe floodings occurring during threatening abortion, or to bring on premature labour in more advanced cases, when the patient was placed in danger by the continuance of an alarming haemorrhage.
the enlarged and inflamed epididymis with the testicle when there is a copious eltusion into the tunica vaginalis, and the diagnosis becomes easy upon the effused fluid being removed. The treatment adopted by M. Marchal is antiphlogistic, with the use of opiate liniment, calomel, laxatives, the recum" bent posture, and support of the scrotum. Where this treat-ment has,been pursued, some induration and swelling will often remain for a time, requiring rest of the organ; and where hydrocele still persists, M. Marchal has frequently resorted to M. Velpeau’s plan of multiple punctures to evacuate the liquid. In the only case of truly inflamed testicle,-parenchymatous _ orchitis,—in the sixty cases of blennorrhagic inflammation, , the usual antiphlogistic measures -having failed to benefit, an incision was made by a bistoury along the whole length of:_ the testicle, dividing its tunica albuginea, after the plan recommended and employed with so much success by M. Vidal de Cassis. As soon as the incision was made, immediate’ relief from the pain followed, and in less than six days the orchitis was completely cured. Before resorting to this apparently severe method of cure, M. Marchal had experimented on a dog, cutting through the tunica albuginea of its testicle,, and slightly into its glandular structure. After four months he examined the organ, and could detect no anatomical differences between it and its fellow, which-had been left w0.touched. In the treatment of epididymitis, M. Marchal also made trial. of a plan which consists in enveloping the scrotum in cottonwool, and, supporting it by a suspensor pressing firmly over the external ring. This method was found to answer in a few slight cases; but M. Marchal abandoned it for more generally useful and sure antiphlogistic measures. s
Onanism; Deathfrom the presence of a Foreign Body within
the Vagina. On the 7th of February, 1848, a young girl, aged eighteen years, was brought to the Hôtel Dieu of Orleans. She appeared in the last state of marasmus, and presented that, peculiar idiotic countenance which so soon follows confirmed, habits of masturbation.She complained of severe pain in the.: hypogastrium, and of diarrhœa, yet steadily refused to have the- abdomen examined. She was so exhausted that no his tory of the case could be obtained; the only fact which trans?" pired was, that she: had been ill fourteen months. The next day she expired. The post-mortem examination was made forty-eight hours ; after death, and brought to light facts such as have seldom; appeared in the annals of onanism. The external parts of generation did not exhibit any corir siderable alteration, except a rather tumefied state of the.; clitoris; but on a further examination, a hard, thin, and Shiaing body was found within the vagina, its breadth occupying;. the whole of the transverse diameter of this canal. On the nymphae aside, the margins of a pewter drink- thrustingwere ing-cup observed; they were rather flattened, and the mouth of this foreign body looked forwards and downwards. This mouth of the cup was half covered by the perinæum, against which it pressed in the manner the head of a ioetus might do in a late stage of labour. It was found impossible to remove this body without the division of the symphysis pubis. The bladder was then opened; it was of very small’ size, and in a contracted state; the hypertrophied mucous membrane had formed pouches lodging five calculi, two of which measured almost an inch and a. half, and the others from a third of an inch to two-thirds, in their greatest dia. meter. These calculi, composed of lithate of ammonia and phosphate of lime, looked very much like, and had the consistence of, the concretions of gravel, and broke easily between the fingers. In following the canal of the urethra, it was Blennorrhagic Inflammation of the Epididymis. found that the same had been completely dividedabout twoM. MARCHAL (DE CALVI) has prosecuted some interesting thirds of an inch above the -meatus by the upper border of researches, in the Hopital Val de Grace, on the history ofthe cup, which was pressing it against the uusterior aspect of epididymitis. In sixty cases of swollen testicle, resulting the pubis, so that the urine ft.:’’..:tl0. its way into the vagina, (the from blennorrhagia, he has found that in two only was the! parietes of which had thus been perforated,) by flowing round testicle itself affected, and in one of these it was but doubt- the exterior of the cup. This explained the presence of a fully so. In the fifty-eight cases it was evident that the thick layer of calculous concretions which were found surepididymis alone was diseased, since, upon an examination of rounding the cup; they were almost a third of an inch thick -
Foreign Department.
’
,
,E
a
11..
paper on
the scrotum, the enlarged-and prominent epididymis is readily felt.
The testis usually seated in front-said to be usually so, because in two instances M. Marchal has found it placed posteriorly-retains its characteristic softness, and if it be compressed, the epididymis being left untouched, the patient complains of no pain; but the contrary occurs if the lastnamed part be meddled with. It is only possible to confound
PLACENTA PRÆVIA.
The
production gave a very good account of our knowledge be pursued in this important devia--
respecting the practice to
tion- from natural labour.- The author did not claim any
originality in his views, and was quite successful in the object he had in view in bringing the subject before the Society, which was, the eliciting the views of the members on this questio vexata. We cannot say, however, that, the debate contained anything more original than the paper. The speakers were Dr. Murphy, Dr. Snow, and Mr. Harding. Dr. REID said, there is a period which has not been adverted to during the evening, and yet it is a most important one, and one which, from the uncertainty attending it, causes the greatest anxiety in the mind of the practitioner. I allude to the eighth or ninth month of pregnancy, when copious hæmorrhage occurs repeatedly, exhausting the patient, and threatenmg destruction on its next recurrence, and yet where no signs of labour have as yet appeared. A practice I have of late followed in such cases is to evacuate the liquor amnii, pass a conically-shaped plug into the os uteri, filling up the vagina behind it, and then to exhibit one or more doses of secale corautum internally. The good effect of this practice, in the few cases in which I have tried it, will induce me to employ it also. for the future. It does not altogether stop the hoemorrhage, of course, but it keepsit for a time within the uterus, where it forms a large coagulum, the presence of which, combined with the irritation caused by the plug, excites uterine contraction, (at this time so anxiously desired.) The os uteri becomes soon much more dilated by the expulsion of the clot, and we are then enabled to introduce the hand and turn the fcetus with more facility; or in some instances the latter, together with the placenta, are speedily expelled. An illiistration of this fact will be found in the following case: On Jan. 28th, I was requested to see a case, with Messrs. Beaman and Wakefield. The lady was advanced to the eighth month of pregnancy, this being her ninth child borne within ten years. She had been seized, during the evening, suddenly with flooding, and, from the effect produced on the system, she must have lost much blood, but there were no uterine contractions. The os uteri just admitted the end of the finger, and the head of the fostus could be felt high up, with a. loose flap of the placenta at.the posterior part. As the flooding continued, it was. determined, at seven P.M., to evacuate the liquor amnii, which was effected by the long trocar generally employed for that purpose, and the plug was inserted in the way described. One drachm of ergot was to be administered likewise. Mr. Beaman, whose patient the lady was, remained in charge of the case, and at half-past nine requested that I should again see it with him,.as the haemorrhage had slightly returned. Mr. Beaman, on making an examination, had found the plug thrust down, with large clots in the vagina, and a considerable re-collection of liquor amnii in a bag of membranes, which were again ruptured. The ergot had been given, and on examining per vaginam, the os uteri was somewhat dilated, with the vertex close to it. In making this last examination I attempted to dilate the aperture, and a labour-pain immediately came on. Four or five more followed in rapid succession, when a fcatus, about seven and a half months advanced, which had evidently been dead for a day or two, was expelled, and the placenta_was extracted by Mr. Beaman immediately after. No haemorrhage recurred, and the lady, although much exhausted by the previous loss of blood, recovered very favourably. The whole labour I should think did not occupy more than half an hour. The same means I have applied with equal advantage in cases of severe floodings occurring during threatening abortion, or to bring on premature labour in more advanced cases, when the patient was placed in danger by the continuance of an alarming haemorrhage.
the enlarged and inflamed epididymis with the testicle when there is a copious eltusion into the tunica vaginalis, and the diagnosis becomes easy upon the effused fluid being removed. The treatment adopted by M. Marchal is antiphlogistic, with the use of opiate liniment, calomel, laxatives, the recum" bent posture, and support of the scrotum. Where this treat-ment has,been pursued, some induration and swelling will often remain for a time, requiring rest of the organ; and where hydrocele still persists, M. Marchal has frequently resorted to M. Velpeau’s plan of multiple punctures to evacuate the liquid. In the only case of truly inflamed testicle,-parenchymatous _ orchitis,—in the sixty cases of blennorrhagic inflammation, , the usual antiphlogistic measures -having failed to benefit, an incision was made by a bistoury along the whole length of:_ the testicle, dividing its tunica albuginea, after the plan recommended and employed with so much success by M. Vidal de Cassis. As soon as the incision was made, immediate’ relief from the pain followed, and in less than six days the orchitis was completely cured. Before resorting to this apparently severe method of cure, M. Marchal had experimented on a dog, cutting through the tunica albuginea of its testicle,, and slightly into its glandular structure. After four months he examined the organ, and could detect no anatomical differences between it and its fellow, which-had been left w0.touched. In the treatment of epididymitis, M. Marchal also made trial. of a plan which consists in enveloping the scrotum in cottonwool, and, supporting it by a suspensor pressing firmly over the external ring. This method was found to answer in a few slight cases; but M. Marchal abandoned it for more generally useful and sure antiphlogistic measures. s
Onanism; Deathfrom the presence of a Foreign Body within
the Vagina. On the 7th of February, 1848, a young girl, aged eighteen years, was brought to the Hôtel Dieu of Orleans. She appeared in the last state of marasmus, and presented that, peculiar idiotic countenance which so soon follows confirmed, habits of masturbation.She complained of severe pain in the.: hypogastrium, and of diarrhœa, yet steadily refused to have the- abdomen examined. She was so exhausted that no his tory of the case could be obtained; the only fact which trans?" pired was, that she: had been ill fourteen months. The next day she expired. The post-mortem examination was made forty-eight hours ; after death, and brought to light facts such as have seldom; appeared in the annals of onanism. The external parts of generation did not exhibit any corir siderable alteration, except a rather tumefied state of the.; clitoris; but on a further examination, a hard, thin, and Shiaing body was found within the vagina, its breadth occupying;. the whole of the transverse diameter of this canal. On the nymphae aside, the margins of a pewter drink- thrustingwere ing-cup observed; they were rather flattened, and the mouth of this foreign body looked forwards and downwards. This mouth of the cup was half covered by the perinæum, against which it pressed in the manner the head of a ioetus might do in a late stage of labour. It was found impossible to remove this body without the division of the symphysis pubis. The bladder was then opened; it was of very small’ size, and in a contracted state; the hypertrophied mucous membrane had formed pouches lodging five calculi, two of which measured almost an inch and a. half, and the others from a third of an inch to two-thirds, in their greatest dia. meter. These calculi, composed of lithate of ammonia and phosphate of lime, looked very much like, and had the consistence of, the concretions of gravel, and broke easily between the fingers. In following the canal of the urethra, it was Blennorrhagic Inflammation of the Epididymis. found that the same had been completely dividedabout twoM. MARCHAL (DE CALVI) has prosecuted some interesting thirds of an inch above the -meatus by the upper border of researches, in the Hopital Val de Grace, on the history ofthe cup, which was pressing it against the uusterior aspect of epididymitis. In sixty cases of swollen testicle, resulting the pubis, so that the urine ft.:’’..:tl0. its way into the vagina, (the from blennorrhagia, he has found that in two only was the! parietes of which had thus been perforated,) by flowing round testicle itself affected, and in one of these it was but doubt- the exterior of the cup. This explained the presence of a fully so. In the fifty-eight cases it was evident that the thick layer of calculous concretions which were found surepididymis alone was diseased, since, upon an examination of rounding the cup; they were almost a third of an inch thick -
Foreign Department.
’
,
,E