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“Perhaps this fatality may be in some degree explained by considering that the exomphalos is most frequently in fat gross subjects, unfavourable for operations; that general intestinal disorder either exists with rupture, or is speedily produced by it; and that irritation and inflammation are readily propagated to the stomach, which is close to the umbilicus."

In the same work we find the following: “The great fatality of the ordinary operation for exomphalos makes it advisable that we should employ every precaution calculated to diminish subsequent irritation and inflammation. Hence it would be proper to adopl, especially if the tumour exceed a moderate size, the mode of operating which is applicable to large inguinal herniæ ; in which the tendon is divided without opening the sack; or the latter part is only cut sufficiently to allow the division of the structure. This will permit the return of the parts if they are not adherent; and if adhesion should have formed, the immediate cause of danger, the strangulation is removed. The approximation of the sides of the wound by sutures, or adhesive plaster, will prevent the occurrence of inflammation in the

The practicability of this mode of operating in umbilical ruptures is fully proved by two cases recorded in the work of Sir A. Cooper, and the successful termination of both instances proved the judgment and sagacity which had suggested that peculiar treatment."

From the concluding remark of the foregoing paragraph it will be perceived, that great credit is awarded Sir A. Cooper for his success in operating without dividing the peritoneal sack.

Too much importance is no doubt attributed to wounding the peritoneum, and this opinion is well established by the recorded cases in Churchill, of Cæsarean operations, in which mothers were saved. We must look to the anatomy of the umbilical ring for the true explanation of the fatality attending operations for exomphalos: and I think we will learn, that to be more successful, we should apply our different means for reduction in quick succession, so that failing in all but the knife, we may resort to it the sooner. If we introduce a finger into the umbilical ring, through which a protrusion which is reducible has taken place, we will at once be convinced from the firmness and unyielding nature of its walls, that a strangulation occurring at this point, would necessarily result in a disorganization of the tissues much more rapidly, than when it takes place at the internal inguinal ring, which is the mouth of a sac (the tunica vaginalis communis) continuous with the fascia transversalis, a thin elastic membrane, capable of considerable distension under any circumstances. Lawrence relates a case of a lady forty-eight years terminating fatally in seventeen hours from the commencement of the strangulation.

Different methods have been given for the division of the stricturesuch as dividing the linea alba downwards, to the extent of an inch; its division upwards has also been recommended, and Velpeau recommends, that several slight nicks be made at different points of the

of age,

of a

ring. Dividing the ring downwards to the extent of an inch, would make so large an opening as to present an obstacle in the way radical cure. In the case related in the first part of this paper, the ring was divided about a quarter of an inch at :he lower part, and this division not being sufficient, a mere nick' at the upper part relieved the stricture. In cases where much cutting would be necessary to relieve the stricture, the plan proposed by Velpeau, enables us to relieve the stricture, without augmenting much the size of the ring, as effectually, as by a single long incision in any direction.

The only cases that I have been enabled to find recorded, in which this operation has been successfully performed, are two cases by Sir A. Cooper, one by Mr. Lawrence, one by Mr. Walker of Hurtsper. pont, one by Velpeau. All the operations mentioned, were upon females. I have not been able to learn, whether the successful ope. ration mentioned before, by Dr. Wistar, was upon a male or female.New Orleans Med. and Surg. Journ.

Health of the Army on the Rio Grande.-We learn from Dr. Craig, chief Medical Director, who has been at Monterey ever since Gen. Taylor marched upon that place, that the general health of the army has greatly improved since cool weather set in; though many are still suffering from intermittent fever dysentery and diarrhæa. Dr. Craig says that the surgical operations performed at Monterey, for the most part, did very well. He performed one operation at the shoulder joint, on the field, which recovered. We should be much pleased if the surgeons on duty would keep us regularly advised of the health of the army.--Ibid.

Prodigious Fæcal Accumulations in the Rectum. By S. A. Cook, M.D.-On the 17th July, 1845, I was called to see F.C., a young lady aged about 15 years. Was informed that she had several times menstruated imperfectly, that she was somewhat troubled with costiveness, and that she had had no evacuation from the bowels during the three days last past. Tongue coated, white, not dry, skin hot and dry, pulse somewhat too frequent, and complained of pain in her head, with perfect loss of appetite. Prescription.--Directed her to take six grains of the following pill mass every six hours. R. Soc. aloes ziij. ; g. scammony, ziss. ; pulv. jalap, 3iij. 1-4; hyd. protochlo., 3i. ; sapo. cast., gr. xv.; nit. pot., 3ss.; tart. ant. 3j. ; oil. anise. arab. muc., aa q. s. to make a mass.

July 18.-Being about ten miles distant, I received a very urgent call to visit her; found her in great pain, like the last pains of labour, the intermissions being very short, yet very perfect ; urgent and painful desire to pass urine, yet none had passed since the morning before, (now 4 o'clock, P. M.) Cathartic pills have not operated, and was now informed that all the evacuations during the past two weeks had been but an occasional scanty discharge of mucu.3, and that such discharges were now being produced, the consequence of the excessive tenesmus. Deciding to introduce a catheter I attempt. ed to pass a finger into the vagina, but was prevented by what appeared to be an unyielding mass, filling the whole pelvis, and pressing upward and forward so as to make it very difficult to pass the finger between it and the pubes. I accordingly carefully insinuated the point of a silver catheter into the urethra and passed it into the bladder, and discharged a quart or more of urine. The tenesmus still continued, and the acuteness of the pain was somewhat relieved, but the involuntary straining effort which characterizes the closing throes of labor still continued. With considerable difficulty I now passed a large-sized gum elastic catheter into the rectum, and through a mass of fæcal matter, some ten inches, when adapting a syringe to the external end of the tube, I succeeded by dint of perseverance in forcing warm water through the plugged orifice of the upper end. After sending up about a quart of fluid, the catheter was withdrawn, and in two or three minutes more than a gallon of fæcal matter followed, consisting almost entirely of the seeds of raspberries. After another small evacuation, which followed in a few minutes, she became entirely comfortable. The next day I was again called, and finding much the same symptoms, resorted to the same means, and obtained a similar result. After this the urinary bladder and the rectum evacuated themselves without aid, and raspberry seeds continued to appear in the fæces for several days longer, though none had been eaten during the week previous to my first calling upon her. Since that time she has enjoyed her usual health.

I present this case to the notice of the profession, not on account of any peculiarity of the practice ; indeed I think it was but what was indicated, and would have readily suggested itself to any reflecting physician; but 1st, To show that a vast amount of fæcal matter may accumulate in the rectum, and also above the sigmoid flexure of the colon, while the sensibility of the mucous membrane remains low as in cases of constipation, but that when this sensibility is increased, as it was in this case by the cathartic, violent symptoms are the consequence ; and 2d, That when the pelvis becomes sufficiently full to distend the perineum, the action of those inuscles associated in the function of expelling the contents of the pelvic viscera is excited, and if this distension be proportionally increased their action becomes intermittent and involuntary. This phenomenon we have all so frequently witnessed in parturition, when the head of the child fully occupies the pelvis and rests on the perineum, that we find it difficult to view it as but a specific accompaniment of that series of phenomena, the aggregate of which constitutes labour. Indeed so strong did this influence operate upon my mind, in this case, that when preparing to introduce the catheter, notwithstanding the youth of my patient, and the character of the family being above suspicion, I could not divest myself of the feeling that, upon the finger entering the vagina, the head of a fætus would present itself. Buskirk's Bridge, N. Y., Jan. 4th, 1847.

Boston Med, and Sur. Jour.

Letter from Persia.--Leeches in Intermittent Fever, &c. We have just heard that the cholera has broken out in Teheran, the capital, though we have no definite information yet of the extent of its ravages. A physician residing in Tabreez, writes me, under date of August 1st, in the following manner : “We are all consternation here, at present, at the news of the cholera being at Teheran. The Prince (Governor of this part of Persia,) is most anxious to take all sanitary measures to prevent its arrival here, and has had communication with Dr. C. and myself on the subject, since which all the Rabab manufactories (cook-shops) have been sent outside of the town, and the selling of fruit diminished. Cleanliness is strictly enjoined, and a fresh supply of water let into the town from the gardens for watering the streets." The disease marched through these parts some twelve or fifteen years ago, and made dreadful havoc of human life. In many cases the natives, when attacked by it, used to throw themselves into a fountain or stream of cold water. The testimony is, as you would expect in such cases, that some lived and some died. By the way, what do you think of Andral's summary of the cholera ? “ Anatomical characters, insufficient; causes, mysterious ; nature, hypothetical; symptoms, characteristic; diagnosis, easy ; treatment, doubtful.”

Are you familiar with the use of leeches, applied over the region of the spleen, in obstinate cases of intermittent fever? I have tried this treatment in two very bad cases, and with the most complete success. A Roman Catholic priest, a native of France, had been my patient some tiine, and I had become almost discouraged in using quinine and arsenic. He became worse and worse, and, dropsical symptoms supervening, his friends thought he would certainly die, and I began to think so too. In this state, I heard that Dr. Bell, Physician to the British Einbassy at the Court of Persia, had used leeches in similar cases with great success, and I determined to try them on my patient. Dr. Bell's mode is to apply them on the day the moon fulls, and to repeat them every full moon until the disease is conquered. Though I had, of course, little confidence that the moon had any thing to do in the matter, I made the experiment exact to the letter, and at the first full moon applied twelve leeches over the spleen, intending to repeat the application at the next full moon in case the disease did not give way. But to my delight, and, I may add, surprise too, the poor priest, sallow and dropsical as he was, began to recover from ihat day, and I had no occasion to repeat the leeches.

I recently made a professional visit to Badr Rhem Bey, the celebrated Roordish chief of Buhtem on the river Tigris. His son, a youth of 12 or 14 years of age, had been suffering for about a year and a half from ague and fever of the quartan kind. He was reduced to a state which gave much uneasiness to his friends. At first I tried a purge and quinine, but without success. Indeed his next attack was more severe than before he had taken the medicine. I concluded to resort to the use of leeches, though some of his friends thought he would certainly die, if he were to lose blood, pale and emaciated as he was. Without regarding the moon as in the former case, I applied six leeches the day before he expected a paroxysm, and on the morning of the next day, gave him two doses of quinine of four grains each. The disease was broken from that time. What comments have you to make on these cases ? Many, many thanks for your Journal. It is always very acceptable. I remain, my dear sir, yours very truly,

A. H. WRIGHT. Oroomiah, August 12, 1846.


Royal College of Surgeons of England.-We cannot afford space for these regulations in full. They may be had at the booksellers, or in our number of last year, of which copies may be obtained at the office. From them it appears that a candidate for the fellowship must be twenty-five years of age ; that he must have "a competent knowledge” of Greek, Latin, French, and the elements of mathematics. It does not, however, appear that what is called a “competent knowledge" of those matters is defined. He must have been engaged in professional study in schools or hospitals for six years, three of which, at least, must have been passed in London. He must have attended a surgical hospital for four years, and a medical one for one, and lectures on anatomy with dissections for three winter sessions ; also, lectures on the practice of medicine, and clinical medicine, sur gery, and clinical surgery, for two sessions, and on chemistry, materia medica, midwifery, medical jurisprudence, and comparative anatomy, for one session. He must also have served as house-surgeon or dresser in a recognized hospital. Bachelors of arts of "English" universities are admitted after five years' study, and are not examined in classics or mathematics. Those who were members of the college in September, 1844, are admitted to examination for fellowship when they are of eight years' standing, and those since admitted, or to be admitted members, are admitted to the same examination after twelve years' standing ; but the latter must have graduated in an English university, or produce a certificate of " competent” classical knowledge. Candidates for the fellowship are examined on “anatomy, physiology, pathology, therapeutics, and surgery,” only; and are required to perform dissectious and operations on the dead body. It does not appear that they are examined on chemistry, the practice of medicine, materia medica, medical jurisprudence, comparative anatomy, or midwifery. They are, in fact, to be pure surgeons, and not general practitioners, and cannot claim to be appointed to mixed medical institutions, such as the Irish Infirınaries and dispensaries. They are to be what is called in England “pure” surgeons.

Candidates for the membership of the College of Surgeons of England are required to produce a certificate of being twenty-nine years of age, and having been engaged in the acquirement of professional knowledge" for four years, and of having studied practical phar. macy for six months. The meaning of “acquirement of professional

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