Gambar halaman
PDF
ePub

parietal convolution. Analysis of these cases shows that the lesion occupied a point near the motor centre proposed for the leg by Curville, Duret, and Ferrier, in only one of them.N. Y. Medical Review.

[ocr errors]

Remedies for Mastitis Puerperalis and Excoriated or Fissured Nipples.-For Mastitis : R Linseed oil, f Ziv; Hydrate chloral, 3 ss.

Powder the chloral very fine, then mix it thoroughly with the oil. Apply, spread thickly, on a piece of soft woollen flannel, a little larger than necessary to cover the breast, with a central opening through which the nipple may protrude.

Apply as warm as can be borne, and keep warm whilst it remains applied, by warm sacks of chamomile flowers or hops. The plaster should be renewed every four to six hours, until all pain, swelling and induration are relieved.

For excoriated or fissured nipples :

R. Powdered nutgalls, 3 j, Oil peppermint, gtt. x. Comp. tinct. opium, q. s. to make a thick paste.

Apply a small portion just after the child nurses, each time. Just before the child nurses, the nipple should be gently cleansed with a soft sponge, and warm tar-soap suds.—Dr. Q. C. Smith in Pacific Medical and Surgical Journal.

Hypodermic Injections of Chloroform. - These injections have been highly recommended by eminent physicians as a substitute for morphine. It is claimed that they are painless, that they relieve pain rapidly and for several hours, and that they are entirely innocuous, being followed by neither local nor general symptoms. Dr. Jochheim, of Darmstadt, however, reports a case in which the injection of only ten drops of chloroform, which is only one half what is frequently administered, was followed by severe local disturbances. Five hours after the injection a violent local inflammation set in, and in twenty-four hours a hard, black slough had formed, which was not cast off by suppuration until six weeks afterwards. — Allg. Med. Cent. Zeit.-Medical Review, N. Y.

On the Diagnosis and Surgical Treatment of Abdominal Tumours.-By T. SPENCER WELLS, F.R.C.S.-[Abstract.]—The first lecture was delivered on Monday, June 10th, at 4 P.m. The lecturer entered at considerable length into the mode of examining patients with abdominal tumours, describing in detail the methods of external, internal, and combined examination, and showed his form of note-book for recording cases.

He described the mode of distinguishing collections of fluid in the abdominal cavity from the collections in cysts, and illustrated, from preparations in the museum, ovarian, renal, and hydatid cysts.

We give the following remarks on combined internal and external examination of the abdomen and pelvis :

“ With the thumb in the rectum and the forefinger in the vagina we can often get an accurate notion of what may be contained in Douglas's pouch ; or, on the other hand, if the thumb is on the cervix uteri and the forefinger in the rectum, it is quite easy to feel a considerable part of the uterus, even to the fundus, and to get a notion of its size and form, or of any. thing attached to its exterior, either in front, behind, or at the fundus.

“ Simon, of Heidelberg, laid great stress on the combined examination of the bladder and uterus after dilatation of the urethra, believing that this was not only useful in completing diagnosis of disease of the bladder itself, but also for examining growths in the vesico-uterine pouch, tumours on the anterior surface of the uterus, or on either side of the pelvis, where they extend forwards. Combined examination between the walls of the abdomen and the bladder may occasionally become necessary. In some forms of uterine disease combined examination may be assisted by previous dilatation of the neck of the uterus with a sponge tent; and in other cases, where examination by rectum alone, or combination of rectal and external examination, may be insufficient, as in inversion of the uterus or cogenital absence of this organ, combined examination by bladder and rectum, either by finger in rectum or sound in the bladder, or finger in bladder after dilatation of urethra, gives all the information required ; but this seldom can be necessary, except in cases of atresia of the vagina.

“ As Hegar has pointed out, if the thumb of one hand in the vagina fixes the vaginal portion of the cervix uteri, the index finger of the same hand in the rectum can not only feel the posterior surface of the uterus distinctly, but can follow the sacro-uterine ligaments ; while, if the other hand presses the abdominal wall backwards towards the sacrum, a very accurate idea can be obtained of the relations of all the pelvic organs. The uterus can be moved in various directions, and anything between it and the bladder or rectum is distinctly felt, supposing of course no extraordinary amount of fat in the abdominal wall, nor any peculiar rigidity in the vagina, interfere. Flexions of the uterus are thus very accurately recognised, and often replaced easily.

“ These examinations must be carried on, sometimes with the patient on her back, sometimes on her side, and sometimes in both positions, and occasionally in the knee and elbow position, with the shoulders low, a change of position of the organs giving information otherwise unattainable.

“ Simon lays great stress on the fact that when a patient is deeply narcotised the whole hand may be passed into the rectum. I have done this occasionally, but have not obtained much additional information than is given by one or two fingers.

“ Hegar deserves the credit of introducing a method of examination which, in some cases, is really of very great value. He fixes the vaginal portion of the cervix uteri by a pair of long hooked forceps, by which the uterus may be ran downwards or on either side. The same object may be obtained more safely by one of Marion Sims's hooks, and there can be no better method of clearing up doubts about the size and position of the uterus, its connexion with neighbouring organs, and especially its relation with abdominal and pelvic tumours.

“I need not say that this must be done with due care ; that no forcible traction upon the uterus must be exercised, and that steadying the organ will often be found quite enough.

“ Suppose the uterus thus fixed and gentle traction made upon it with one hand, and one or two fingers of the other hand are passed into the rectum, the posterior surface and sides of the uterus are felt, and, if necessary, the finger may be carried over the fundus. Sometimes the forceps or hook may be given to an assistant, while one or two fingers of one hand in the rectum and the other on the abdominal wall effect a combined examination of the most complete character. The connexion of the abdominal tumours with the pelvic organs may be very accurately made out. A slight pull on the uterus may be sufficient to clear up any doubts as to the connexion between the uterus and the tumour, while the pedicle or membranous adhesions with the rectum may be made tense and felt.

Supposing a tumour is partially or entirely in the pelvis, in more or less close apposition with the uterus, by drawing the uterus downwards or forwards on to one or other side, the examining fingers in the rectum may follow the outlines of the tumour and notice how its movements are affected by the movements of the uterus, or if it may be seperated from the uterus. It is by no means unfrequent that you can separate the uterus from a tumour where previously there had seemed to be intimate connexion, or union apparently inseparable. The assistant

. drawing down the uterus or to one side, with two fingers in the rectum and the other hand over the abdomen, pushing up the tumour, we may often get an idea of the length of the pedicle, and in reference to uterine fibroids information as to the possibility of removing them. You find out the length and thickness of the cervix, whether it is fixed or movable, and whether it is involved in the new growth. You pull, as it were, the neck of the uterus out of the mass which in a measure involved it, and this shows the tumour to be a growth which may be removed.”

The lecturer then described the chemical character of the fluids removed by tapping in ascites and in ovarian cysts, reserving the microscopical characters for the second lecture.

In the second lecture, delivered on Wednesday, June 12th, Mr. Wells described the microscopical elements found in ovarian fluids, dwelling especially on Drysdale’s granular ovarian cell, and on certain groups of large pear-shapeå vacuolating cells observed in peritoneal fluid in cases of cancer of omentum and ovary. The remainder of the lecture was occupied by the demonstration of specimens from the museum, to illustrate the diagnosis of different forms of multilocular, dermoid, and solid ovarian tumours from the various abdominal tumours for which they may be mistaken. Very interesting specimens of splenic tumours removed during life by the lecturer were shown, large tumours of the kidney and liver, a large gall-bladder with thick walls, hydatids of the omentum, aortic aneurisms, false cysts formed by adhesions the result of chronic peritonitis, numerous specimens of intra-abdominal cancer, extra-uterine pregnancy, and tumours of the abdominal wall. The very rich collection of uterine tumours in the museum was reserved for the last lecture of the course.The Lancet.

Idiopathic Mydriasis, treated with Eserine.-A. STANFORD MORTon, in the British Medical Journal, observes : Mr. Benton's case of Idiopathic Mydriasis, treated with Eserine, recorded in the Journal of July 13th, is interesting, as showing the immediate and beneficial effect of sulphate of eserine, where Calabar bean liscs and solution of extract of Calabar bean had been employed without any result. I presume, where it is stated that “ the patient was suffering from great pain in the left eye, occasioned (as was at once apparent) by dilatation of the pupil,” it is meant that the pain and dilatation were produced by the same cause; and whatever this may have been, I should be very glad if Mr. Benton would give us any further information as to how he arrived at the conclusions that “the impairment of vision was due solely to the dilated pupil ;” and that “ there was no loss of accommodation, as the patient could see to read quite plainly through a pinhole aperture in a piece of card held close to the eye;" for the following cases, which have come under my observation, would seem to show that a patient, having mydriasis, without loss of accommodation, may read small type even without a pinhole aperture; and further, that a patient, with combined mydriasis and suspension of accommodation, may even read brilliant type through a small aperture.

« SebelumnyaLanjutkan »