« PreviousContinue »
membrane, remaining rich in vessels dilated into sinuses, has not become deciduous, at least in a direct manner. This is owing to the circumstances that its vessels are continuous with those of the muscular wall, and that being vascular, it has continued to nourish itself. This peculiarity strikes the more because we are always astonished at seeing, on dissection, how slight the proper tissue of the mucous membrane which forms this membrane is, compared with the diameter of the large sinuses between which it is placed in the shape of thin layers or bands of separation. This tissue is reddish, deeper than the proper decidua. Lastly, and this fact is important, there has not been produced between the serotina and the muscular coat of the uterus a new thin substitution-mucous membrane, such as exists between this latter and the decidua vera. It is only little by little, during the locbial discharge, that it exfoliates and is eliminated. Then only is the serotina replaced by the thin substitutionmucons membrane.
In the woman dead some days after delivery, the remains of the inter-atero-placentary decidua are found, forming a layer much thickened by the contraction of the uterus, which throws it up into a smaller area. From the projecting irregular borders of this membrane is continued the new thin mucous meinbrane which clothes the rest of the uteras. This last is rosy, generally smooth, a little shining, except when blood or bloody or purulent mucus covers it. On the contrary, the thick layer of the serotina is rough, as if tuberculous, and irregularly mamelonated. It is easily scraped off; its colour is reddish or greyish, verging upon black; sometimes on the summit of the elevations of the surface it assumes a grey tint, from true mortification. It is not rare to perceive at the surface of this laver some vascular orifices, plugged by fibrinous coagula. If traced by scissors, we are soon led into tbe sinuses of the muscular coat. We are struck by the areolar cavernous aspect given to this layer by the numerous anastomoses of these large vessels, when opened. In autopsies of puerperal fever, this rough, blackish, pultaceous layer has been mistaken for remains of placenta adhering to the uterus, and in process of decomposition.
Second Part. On the modifications undergone by the epithelium of the body of the uterus during gestation. The epithelium of the uterine neck preserves, as is known, its cylindrical state, losing only the vibratile cilia on the most of its cells. It is not so with the epithelium of the cavity of the body. Having examined several gravid uteri of 2, 21, 3, 5, 6, and 71 months, I have ascertained that this epithelium passes gradually from the cylindrical, or rather prismatic form, to the pavimentous condition. There is no fact to prove that it is the prismatic cells which directly assume the pavement form. Everything shows that a certain time after fecundation the epithelium of the cavity of the uterus exfoliates cell by cell, or by small shreds, then what replaces it is an epithelium, pavimentous, of large cells. These have a spherical or slightly ovoid nucleus, about the size of a blood-globule. Deep yellow granulations almost completely fill the mass of the cell. Many cells are wanting in nuclei, and are uniformly filled with these yellow fatty granulations. This condition of the cells is met with froin the sixth week to the second month, both on the decidua vera and reflexa. From two months and a half there are seen in addition many other cells, much larger, and especially much longer. Their nucleus is larger, they are pale, little granular. These large elongated irregularly-shaped cells go on increasing in relation to the first according to tho advance of gestation, and are far the more numerous near the term.
2. Dr. Riedel has tested the propositions of Dr. Blot relative to the physiological occurrence of sugar in the urine of puerperal, suckling, and pregnant women. Dr. Riedel examined the urine of eleven puerperal women, and three pregnant. The urine of the first class was taken at periods varying from twelve hours to twelve days after delivery. Two of these women were not suckling. Of the three pregnant women, one was in the sixth month, the other two apparently in the last month. The tests employed were boiling with liquor potassa, and Trommer's. The result was negative in all cases.
1. Tro Cases of Infants born Asphyxiated, Reanimated by Marshall Hall: Method. By
Smith WARNER, M.D., Ga. (Charleston Medical Journal, Jan. 1858 ) 2. Difficult Labour from Membranous closure and Rigidity of 08 Uteri~ Incisions. By
PROFESSOR Howl. (Monatsschrift für Geburtsk.) 8. Several Cases of Placenta Previa Centralis, treated after my Method. By Dr. COHEN.
(Monatsschrift für Geburtsk. Nov. 1857.) 1. Dr. Warner, of Lumpkin, Ga., U. S., records two cases of asphyxiated infants restored by the Marshall Hall method. In the first case it is reported that the cord was pulse
less, but it is not shown that respiration was inexcitable. The rotations were successful in thirty minutes. In the second case, blowing on the chest and dashing cold water proved useless. The respiration was therefore inexcitable. Rotation was quite successful at the end of thirty-five or forty minutes.
2. A woman aged thirty-seven, very large, but of relaxed habit, who had aborted once at four months, and again at six months, had reached the normal time of gestation. Pains came on with great violence towards the morning of the 28th July, lasting till midday, when the waters broke, and after a short pause the pains returned with still greater violence. It was now found that the uterus was strongly inclined at the fundus to the right side, and contracted regularly at each pain. It was remarkable that in the interior wall, right under the navel, was an apple-sized swelling of harder consistence than the uterine wall, apparently a fibroid. The parts of the child were plainly felt, the fætal pulse and placental rush were heard on the left side. The soft passages were dry and unyielding. The os uteri gave passage to the finger. This continued all through the night, the head only being driven a little lower down. On the following day, no advance was perceived; but it appeared as if a thin membrane were stretched between the two lips of the os uteri, preventing its expansion. This was therefore divided, and immediately the os opened somewhat. Its edges remained very sharp. This condition remained throughout the day, notwithstanding resort to cramp-allaying remedies, and warm vapour-baths to the vagina. The head continued to be forced lower down, and the lower segment of the uterus was yet more strongly distended. On the morning of the third day, intense pain appeared on touching the upper part of the uterus; and the hitherto tranquil pulse began to rise. It appeared that longer continuance of labour was undesirable. Fresh incisions were therefore made in the whole circumference of the os, with the slight good effect of leading to a dilatation of the size of a dollar. But there progress stopped. The child died, and began to putrify; gases were developed, and escaped during pains froin the uterus. Fresh dilatations were therefore made in three directions, three hours after which a further expansion of the os was manifest. Thirty-six hours later the forceps was applied, and the head delivered. The mother fell ill with phlebitis of the left crural vein, which, however, subsided, and she recovered. [In this country, the labour would have been shortened by forty-eight hours at least by the resort to craniotomy, which, as the child was dead, was an operation eschewed without adequate reason in the present instance.—REPORTER.]
3. Dr. Cohen relates several cases of placenta prævia centralis, treated by the method of partial detachment, and conversion into placenta lateralis. This he does in reply to an expression of regret uttered by Dr. Barnes, in December, 1855, that his memoir detailing his views embraced no clinical illustrations. Dr. Cohen's first recorded case occurred in December, 1856.
Madame T-was delivered on that day, having expected delivery at the end of January. The first flooding appeared in the last week of the sixth month, six weeks before delivery. From this time, about every eight or fourteen days, profuse floodings returned, but were quickly suppressed by recourse to horizontal position. On the 1st December, watery discharges took place (it conld not be ascertained that these were amniotic). On the 3rd December, slight pains come on. On the 7th stronger pains, and more copious bleedings. At nine P.m., the os uteri was found slightly dilated, centrally covered by placenta, pains inconsiderable, pulse small
, face anæmic; no movements of fætus felt for some time. It was found that the smaller flap of placenta was attached to left wall of uterus; the mass, therefore, lay on the right side. The smaller left flap was detached by the finger. The bleeding was immediately and definitively arrested. The arm and cord were presenting. The os dilated more and more, and the pains increased. After two hours and a half, the child was turned, and easily delivered. The child had long been dead: there were marks of docomposition. The patient did well.
2. Madame P-was delivered, on the 13th January, 1857, at the normal term. Flooding broke out suddenly at three P.M., no bleeding having occurred before. The flooding was profuse, with faintings. First seen at five P.m. The os was but slightly opened. Plug inserted. The bleeding, however, ceased for a short time. Soon strong pains came. Plug removed. The os was now more dilated. The smaller flap was on the right side, the mass on the left. The smaller flap was detached by the finger. The bleeding entirely ceased. The labour proceeded naturally, as in ordinary head-presentation, without a drop of blood. At ten p.s., a dead child was born. No fætal movements had been felt all day. Puerperal week normal.
3. Madame M- delivered on the 27th January, 1857, within fourteen days of last month of gestation. In the first week of the eighth month-that is, six weeks before delivery-flood
ings occurred several times. From the end of the eighth month-that is, fourteen days before delivery-floodings were renewed several times in a day, but not in great quantity, and were lessened by horizontal posture. Five days before labour, violent flooding, accompanied by slight pains, so as to require a plug. The os was closed, the cervix not obliterated. Flooding ceased for three days, then patient complained of strong pains. The plug was removed; but Dr. Cohen thinks it would have been better to leave it until the pains should expel it, for the bleeding stopped, and there was no internal hæmorrhage. The cervix was now obliterated, and the os open to the size of a shilling. No fætal movements felt throughout, nor fætal pulsation heard. The bleeding returned more strongly after the plug was removed. The smaller flap of placenta lay on the right. The os was now softer. This flap was detached by the finger. The bleeding instantly ceased. The os uteri, however, contracted rather than expanded. It is to be remarked that Madame M— had all her life been subject to spasmodic hysterical affections. Not urged by flooding, and satisfied that the child was dead, Dr. Cohen felt he might safely wait. Twelve hours before delivery, the greater flap of the placenta was detached spontaneously, and the whole placenta was driven by the pains into the vagina. The os uteri dilated tediously under nervous symptoms peculiar to the patient's constitution. In twelve hours, delivery was effected by turning, the child's shoulder presenting. The patient did well.
[It is to be remarked—1st. That in all these cases hæmorrhage took place although the child was dead; so that these instances may be added to others recorded by the Reporter, to negative the explanation offered, that when the flooding in placenta prævia ceases spontaneously, it is because the child is dead. 2ndly. That, concurrently with the artificial partial detachment of the placenta and the arrest of flooding, decided uterine contraction set in. 3rcly. That, the flooding being arrested, time was gained for the normaľ progress of the labour, so as to admit in two cases of turning and the passage of the child, without use of dangerous force. 4thly. That in the last case the placenta was wholly cast off and expelled before the child; but that the cessation of the hæmorrhage dated from the partial cervical detachment; but for the accurate observation of Dr. Cohen, this case might be cited as a proof of the efficacy of total detachment in arresting hæmorrhage, as many similar cases have been, which, if rigidly analysed, would simply prove the hæmostatic agency of cervical detachment and contraction. 5thly. That there appears a fallacy in Dr. Cohen's theory and practice, ir limiting the detachment to the smaller flap only. It is a matter of common experience that in lateral-cervical placenta, where there is no smaller flap passing over the os-that is, where the whole placenta is attached to one side only, but coming down to the edge of the os, precisely in the condition brought about by the operation of Dr. Oohen-we still have flooding, dangerous flooding. It follows, therefore, that this operation may be expected to prove ineffectual; and probably would have proved so in the present cases but for the advent of strong contraction. The Reporter submits that for these reasons, and others detailed in his work On Placenta Previa,' the operation recommended by him of detaching all that portion of placenta which adheres within the cervico-orificial zone, is the proper one to be performed. --Rep.)
The Inauguration of Jenner's Statue. The 17th of May, 1858, is an era in British science, for on this day, for the first time, the same honour has been publicly paid to a man of science and a philanthropist which has hitherto been thought the exclusive due of military and political eminence. The statue of Jenner, in spite of the opposition of some who profess to march in the vanguard of civilization, now occupies one of the most prominent positions in the metropolis of Great Britain; a sign to the people of what persevering energy, combined with scientific sagacity, may accomplish to the advancement of human happiness; a proof to the labourer in the cause of science and humanity that, if he achieves something worthy of his country's gratitude, that country henceforward may reward him as she has hitherto rewarded the heroes of another stamp. It was a noble sight to see the assemblage of peers, of distinguished commoners, and of the most eminent in the medical profession, which, on the 17th of May, united, at the Royal College of Physicians, under the presidency of His Royal Highness the Prince Consort, to do honour to the great name of Jenner. It was touching to hear men who form a link between the last generation and the present one, like the illustrious Marquis of Lansdowne and our professional brother, Dr. Pettigrew, speak of their personal reminiscences of the mun; the former the first nobleman to recognise his merit, and to come forward in his support—the mover in the House of Commons of the resolation to confer a grant of 20,0001, upon Jenner, not as a reward, but as an indemnification; the latter, one of the personal friends of Jenner, and one of the oldest vaccinators in the kingdom. It is unnecessary for us in this place to arge the importance of vaccination, but we would fain hope, with the Royal President of the meeting, that its result may be to arouse the attention of the public to the merits of the great discoverer of vaccination, and that it may be the means of preventing that neglect of vaccination, owing to which, in this country, no less than 5000 persons still fall victims to small-pox annually.
A Contribution to the Curiosities of Medical Literature. The French Society of Surgery has recently been subjected to a mystification which, to all but the persons immediately interested, may appear somewhat amusing, were it not that ethical principles are involved which forbid the rising smile. A work on stricture of the urethra was presented to the Société de Chirurgie in December, 1856,* in which the author, Dr. Pró, claims the merit of having made, at the suggestion of M. Malgaigne, extensive personal investigations on the subject, especially in the pathological museums of London. What he terms the travail spécial, qui forme pour ainsi dire le corps du mémoire, occupying about 25 out of the 122 pages of the work, is a verbatim translation of a part of Mr. Henry Thompson's well-known work,t which received the Jacksonian prize for the year 1852. No acknowledg. ment of the source from which Dr. Pró bas obtained such valuable assistance is given, and the translation is so well done, that we can understand how the referees of this society, who reported well on the memoir, and who could not be familiar with Mr. Thompson's work, should have been deceived into the belief that the production before them was a bonâ fide work of the professed author. It appears that Dr. Pró is not a Frenchman, and we should imagine that he must be unacquainted with the facilities of intercour:e, personal and literary, wbich exist thoughout Europe, but especially between France and Great Britain, otherwise he could not have ventured upon such an act of plagiarism. The assurance of subsequent detection would have been a sufficient check upon him. We much regret, for the sake of the distinguished men who formed the commission to which the book was referred for examination, that they should have been led to regard the work as the result of Dr. Prú's labours, whereas the most important parts belong to Mr. Henry Thompson. We can well conceive their annoyance on the circumstances being pointed out to thein. At the same time, it is proper that such an act of literary pirucy should be loudly proclaimed, and that a well-earned reputation should not suffer through a maudlin sentimentality in favour of the calprit. We unilerstand that steps have already been taken to prevent the recommendation of the Commission from taking effect-viz., that the author should be made a corresponding member of the Société de Chirurgie.
The Medical Officers in Lucknow. Those who bave followed the story of our reverses and of our successes in India, cannot fail to have noticed the unform devotion and gallantry of the medical officers It affords us particular pleasure to extract from the General Orders issued by the Governor-General of India after the liberation of General Inglis and his brave fellow-sufferers, the following testimony to the distinguished services given by our professional brethren duriog that trying siege :
The medical officers of the garrison are well entitled to the cordial thanks of the Government of India. The attention, skill, and energy evinced by Superintending-Surgeon Scott; Assistant Surgeon Boyd, her Majesty's 32nd Foot; Assistant-Surgeon Bird, of the Artillery; Surgeon Campbell, 7th Light Cavalry ; Surgeon Brydon, 71st Native Infantry; Surgeon Ogilvie, Sanitary Commissioner; Assistant-Surgeon Fayrer; Assistant-Sargeon Partridge, 2nd Oude Irregulars; Assistant-Surgeon Greenhow and Darby, and of Mr. Apothecary Thompson, are spoken of in high terins by Brigadier Inglis.
* Mémoire sur l'Anatomie Pathologique des Rétrécissements de l'Urethre. Par José Pró, Docteur en Médecine de la Faculté
de Paris. Paris, 1856. Pp. 122. + The Pathology and Treatment of the Urethra, both in the Male and Female. By Henry Thompson, F.R.C.8. London 1854.
"To Dr. Brydon especially the Governor-General in Council would address his hearty congratulations. This officer, after passing through the Cabul campaign of 1841–2, was included in the illustrious garrison who maintained their position in Jellalabad. He may now, as one of the heroes of Lucknow, claim to have witnessed and taken part in an achievement even more conspicuous, as an example of the invincible energy and enduring courage of British soldiers."
BOOKS RECEIVED FOR REVIEW.
The Continental Review, No. 8, Vol. I.
Untersuchungen über das Cylinder Epithelium der Urethro-vaginal and Vesico-vaginal Fistules. By N. Darzmotten. Von J. Bretauer und S. Steinach. Wien, Bozeman, M.D. Montgomery, U.S., 1857. (Reprint.) 1857. Reprint.
Gazette Médicale d'Orient, March and April, 1858. Medical Jurisprudence. By Alfred 8. Taylor, M.D.,
Changes in the Residence required by the University for Transactions of the National Association for the Pro- Degrees in Medicine. By G. W. Child, B.M. Oxford, motion of Social Science. Inaugural Addresses and Se- 1858. pp. 19. leet Papers. London, 1858. Pp. 608.
An Essay on Physiological Psychology. By Robert Evil Results of Over-feeding Cattle. By Fred. J. Gant, Dann, F.R.C.S. London, 1858. X.R.C.S. London, 1858. Pp. 89.
The Painless Extirpation of Cancerous. Growths by Transactions of the Odontological Society of London, Congelation and Caustics. By James Arnott, M.D. Lon1856-57. London, 1858. pp. 154.
don, 1868 The Human Mind in its Relations with the Brain and A Manual of Psychological Medicine. By John Charles Nervons System. By Daniel Noble, M.D. London, 1858. Backnill, M.D. and by Daniel Tuke, M.D.' London, 1858. Pp. 158
On Dislocations and Fractures. By Joseph Maclise, Handbook of Chemistry: Theoretical, Practical, and F.R.C.S. Fascic. III., IV. London, 1858.
Technical. By F. A. Abel, and C. L. Bloxham. Second On Certain Irregularities of the Teeth. By Charles Edition. London, 1858. pp. 785. Gaine, Bath. No Date.)
The Institutes of Medicine. By Martyn Paine, M.D. Lehrbuch der Allgemeinen Chirurgie. Von C. F. Loh- New York, 1858. pp. 1095. treger, Dr. Med. Lahn, 1858, pp. 258.
The Unity of Medicine. The Corruptions and Divisions, Materia Medica, or Pharmacology and Therapeutics. as by Law established in England and Wales. By a FelBy Williain Tully, M.D. Vol. I. Parts 1 and 2. PP. low of the Royal College of Surgeons. London, 1858. 1534 The Assurance Magazine, April, 1858.
An Experimental Inquiry into the Effects upon the The Nature anil Treatnient of Cancer. By George Mother of Poisoning the Fætus. By W. S. Savory. LonSontham, F.R.C.S. London, 1858. Pp 47. (Reprint.) don, 1859.
The Indian Annals of Medical Science. Jan. 1868. Local Government. A Bill to amend the Public Health Seventh Annual Report of the Wilts County Asylum, Act, 1848. Ordered by the House of Commons to be Devizes, for the year 1857.
printed. 1858. Das Wesen und die Entstehung der Spondylolisthesis. A Few Additional Suggestions with a view to the ImVon Dr. Wilhelm Lambl Würzburg, 1857. (Reprint.) provement of Hospitals. By Mr. John Roberton. 1858. Exencephalitische Protuberanzen am Schädeldach. (Reprint) Von Dr. Wilhelm Lambl (Reprint.)
The Spread of Cholera by Personal Communication, as The Medical Practitioners' Bill. Explained in a seen in the Crimean Campaign. By A. W. P. Pinkerton, Speech delivered by the Rt. Hon. W. Cowper, M.P. Lon- M.D. Extinburgh, 1858. (Reprint.) don, 1858.
On the Sanitary Condition of the British Army. By Die Complicirten Luxationen. Von Dr. Albert Schin- W. A. Guy, M.B., F R.C.P. London, 1858. (Reprint.) zinger. Lahr, 1858.
The Influence of Sewer Emanations, By T. H. Barker, Cyclus Organisch Verbundener Lehrbücher Sämmt- M.D, London, 1858. pp. 19. licher Medicinischen Wissenschaften. Schiff, Lehrbuch Medical Opinion in the Parish Will Case. By Pliny der Physiologie. 1 Heft.
Earle, M.D. New York, 1857. pp. 50. (Reprint.) Suggestions and Instructions in reference to-1. Sites. Report of the Pennysylvania Hospital for the Insane, 2. Construction and Arrangements of Buildings. 3. Plans for the year 1857. By F. S. Kirkbride, M.D. Philadel of Lanatic Asylums. Ediuburgh, 1858. (Lunacy Board.) phia, 1868. pp. 48.
Tenth Report of the Somerset County Lunatic Asylum. Minutes of the Proceedings of the Quarantine ConvenWells, 1868
tion held at Philadelphia, 1857. Philadelphie, 1857.
Essays, Scientific, Political, and Speculative. By Her- don, 1858. Pp: 100.
Letter from Mr. Hussey to Dr. Child, on the Proposed
Chroniques de l'Uterus. Par le Dr. Willemin. Paris, Untersuchungen zur Näheren Kenntniss des Banes der 1837. pp. 247. Quergestreiften Muskelfaser. Von Alex. Rollert. Wein, Lehrbuch der Geburtshülfe. Von Dr. Otto Spiegel1357. (Reprint.)
berg Lahr, 1858. pp. 376. Osservazione Chimiche sulle Reazioni per le quali la A Manual of Obstetrics, Theoretical and Practical. By Cristallina si dovrebbe Distinguere dall' Albumina. Fatte W. Tyler Smith, M.D. Illustrated. London, 1808. Pp. dal Dottore, M.C. de Vintscbgau. Wein, 1857. (Reprint.) 628.