Gambar halaman

the aneurismal dilatation of the osseous capillaries may be found in the fact that in most cases external injuries have been the producing causes. Another material difference resides in the fact, that these tumours occupy indiscriminately the arterial or venous capillaries in the soft parts, and exclusively the arterial system of bones. A cancerous cement not unfrequently is superadded to the vascular transformation, and when this unfortunate complication is observed, the fatal result of organic disease are produced even before abundant hemorrhage could supervene. You are aware gentlemen, that, for the treatment of these erectile tumours of the soft parts, numerous methods are employed, and particularly within the last few years the progress of the art of curing has been, in this respect, truly remarkable. We recollect that twenty-five years ago, amputation was freqnently considered as the only resource in cases which now-a-days would obtain relief by a great many plans, differing with circum. stances, and with surgeons. Ligature, pressure, cauterization, puncture-simple, or combined with the application of heat or of electricity : such are the principal methods of treatment which would be resorted to.

As to fungous tumours of the bones, we know only of three operations by which a cure can be obtained : ligature of the main artery of the limb, amputation of the extremity, and, in some few instances, resection of the portion of bone occupied by the malady. Ligature we prefer, in the present instance, for reasons which we will expose in another lecture. -London Medical Times.

Two Cases of Rupture of the Uterus-Recovery of One.-M. Robiquet was called to attend, in labour, a female, ætat. 32, who had previously had one child, and had never suffered under any symptoms of uterine disease ; the present, her second pregnancy, had gone on favourably until about two hours before M. Ri's visit, when during a strong uterine contraction she felt something suddenly give way within her. It seemed to her as if her bowels had been torn, but soon an apparent calm succeeded this painful sensation.

On M. R.'s entrance he found the patient's countenance flushed, her skin moist, pulse 90, small and thready, respiration slow but regular; she had acute pain in the abdomen, with the sensation as of a weight rolling about in the middle of the belly and crushing the intestines, the uterine contractions were few and transient. T'he abdomen, depressed and irregular, had lost its rounded form, and permitted the limbs of the fætus to be distinctly felt, and easily laid hold of through its parietes ; and the child swayed from right to left, according to the moyements of the patient. On vaginal examination, the head of the fætus was felt at the uterine orifice. This latter circumstance induced M. R. to wait a short time, but finding that the powers of the mother were being rapidly exhausted, he applied forceps and extracted a female child, which lived only a few minutes. Scarcely was the fætus expelled, when a soft rose-coloured slightly inflamed mass projected from the vagina and hung down between the thighs of the patient; this was at once recognized as part of the small intestine and the epiploon. M. R. at once returned the intestinal mass into the vagina, and gently pushed it onward to the fundus of the uterus, in which, rather to the right side of that organ, he found an opening large enough to admit his hand to pass through easily. Having at length with some difficulty returned the whole intestinal mass through the wound, he passed his right hand through the laceration so as to cover its aperture, while with his left, externally, he used frictions over the hypogastric region, with a view of inducing uterine contraction, and for the same object fifteen grains of ergot were administered. After a lapse of two or three minutes, M. R. felt the edges of the wound to approach, and the body of the uterus to make some efforts at contraction. After a second contraction had considerably diminished the diameter of the laceration, M. R. gently drew his hand out of the wound into the cavity of the uterus, and applied it to the inner surface of the rupture, to prevent any projection of the intestines through the opening. A second dose of ergot had been previously administered, and in a short time the uterus contracted so powerfully that he was compelled to withdraw his hand from its cavity. A dan. gerous attack of metro-peritonitis followed, which was successfully treated in the usual manner. Symptoms of inflammation of the uterus continuing on the second day after delivery, M. R. introduced two fingers into its cavity, and finding a small knuckle of intestine protruding, he successfully effected its reduction. From this time the patient gradually improved, and was at length restored to complete health.

Second Case.-The following recently came under the notice of M. Dubois at the Clinique d’Accouchements :—The patient, ætat. 32, arrived at the termination of her third pregnancy, without any unsavourable symptoms. On the 9th June labour set in with pains, feeble, and recurring at long intervals. On the following day the membranes ruptured, accompanied with trifling hemorrhage; the labour pains ceased, and were replaced by continued and intermitting pain. The medical attendants, being ignorant of the true cause of the cessation of uterine contractions, administered ergot, in order to restore them. At noon of the same day the os uteri was completely dilated, the fætal head resting at the brim, but no attempt was made at artificial delivery ; at six in the evening she was carried to the Clinique in the following condition :- There was general lividity of the surface of the body; the features were contracted, and the radial pulse imperceptible. M. Dubois was called, and at first supposed that the patient laboured under cholera ; but, having heard an account of the case, immediately recognized it as an example of rupture of the uterus. On applying the stethoscope the child was found to be dead ; forceps might have been applied, but M. Dubois declined to interfere under the circumstances of the case, on the ground that any interference would have hastened the patient's dissolution, and would uselessly compromise the obstetrical art in the eyes of the public, who are always disposed to judge wrongly : the patient died in a few minutes after. On examining the body after death, an extensive rent was found in the right side of the uterus, reaching from the orifice of the organ to the round ligament, passing through the entire thickness of the substance of the uterus, but leaving its peritoneal tunic quite uninjured. In both of the preceding cases the rupture was spontaneous, and not the result of ill-directed mechanical interference. We must therefore admit, says the reporter of the cases, an organic predisposi. tion to laceration of the uterus, which is probably nothing else than an inflammatory softening of its tissue. In both of the cases, too, the rupture was in the right side of the uterus, instead of in its anterior surface, as it is more generally observed. We agree with the reporter, in thinking that M. Dubois' motive for non-interference, viz.“ a fear of public opinion, which is always wrong," is, more especially in one of his reputation and experience, a very ridiculous, and possibly a highly dangerous, guide in practice.- Monthly Jour. of Med. Science, from Journ de Med. et de Chirurg.

Prolapsus of the Vagina, Laceration of the Unimpregnated Uterus, and Protrusion of the Uterus.-In the preceding page there has been recorded a case of laceration of the gravid uterus, with protrusion of the intestines through the rent, and the following case is an example of a similar injury in the unimpregnated condition. The patient was 60 years of age, and had borne seven children ; she suffered under prolapsus of the vagina, and having never applied for medical advice, nor adopted any remedial measures, the affection proceeded from bad to worse ; the sense of weight and dragging in the hypogastric region, the tenesmus, and dysuria became so severe, that she, by degrees, found herself less able to maintain the erect position, and was ultimately compelled to rest her head constantly upon her knees. On the 12th October, M. le Chaptois was called to her assistance ; upon entering the room he was struck by the fetid cadaverous odour which exhaled from the bed in which the patient lay, in a state of profound prostration. An enormous mass of small and large intestines had protruded through the uterus, which was torn and dragged down by the mass; the womb was everted, and hung between the thighs like the finger of a glove ; near the angle of the right Fallopian tube there was a laceration of nearly four inches in length, which had given passage to the intestinal mass. The patient had, for some hours, been speechless ; the pulse was small and weak, and she was, to all appearance, moribund. M. le Chaptois, notwithstanding her desperate condition, having carefully washed and cleansed the viscera returned them with his hand into the pelvic cavity; they were then maintained in their place by the introduction of a sponge into the vagina. During the succeeding night the patient vomited frequently, and suffered from convulsions; but, after the bowels bad been freely moved, an amelioration took place, and the case proceeded to a favourable termination.-Ibid from Ibid.

On the Constitution and Functions of the Cervix Uteri. By M. NEGRIER.--The following are the most important conclusions which M. N. draws from his investigations. The superior orifice of the cervix endeavours to contract powerfully the instant that the dilating body, whether the ovum or the fætal head, has passed out of it; the superior orifice alone may oppose an obstacle to delivery, it alone may incarcerate the placenta, whereas the inferior orifice, when it has been fully and slowly dilated, returns to its ordinary size after a considerabie time, and gradually. In females who are delivered for the first time, the orifices of the cervix contract before the walls of its cavity; and in women who have been delivered more than once, the lips of the external orifice close more slowly than the cavity of the cervix ; and in all women the parietes of the cervix are thrown into folds from above downwards. These perpendicular folds result from the closure of the superior orifice, and are not entirely effaced even ten days after delivery. In cervical implantation of the placenta, M. N. seems to prefer plugging far before any other mode of treament. -Ibid, from Arch. Gen. de Med.

Chinese ideas respecting the Anatomy of the Circulating System.The heart is figured low in the thorax, is considered a single cavity, and the reservoir of good things; it has little active connection, none that can be traced with the general circulation. From above, the windpipe passes directly into it ; while from below, the tube of a second, elective stomach, connected with the first, recipient stomach, by some kind of conduit, enters it at nearly the same point with the windpipe. Short work is thus made with the complicated and mysterious process of assimilation. One vessel proceeds from the heart to the liver, and another descending along the course of the spine, after communication by a broad reservoir-like expansion, with the kidneys, it is presumed, terminates in the genitals. There is, besides, a double canal, connecting the heart at a point near its apex, with the tube last noticed. But what all those things mean, and what part, if any, the heart acts in propelling the blood, the professor who was asked to explain what appeared in the plate, failed to show. Chinese notions regarded the circulating system, as on most other subjects, are peculiar to themselves, and differ entirely from those entertained by European physiologists, anterior to the time of Harvey and Servetus. In this, as in other vital actions, they introduce the sexual system. They have some idea of difference between arteries and veins, but what it is, and what offices they assign to each, could not be ascertained.

The arteries are said to be male and female. Of the former, three, belonging to the hand, proceed from it to the head; while three, be

onging to the foot, originate in the hand, whence they descend to their proper place. On the other hand, three female arteries proceed from the bowels to the hand, to which they belong; and three, belonging to the foot, originate there, and then proceed to the intestines.

Besides these vessels, there is the pulse artery, which moves with every respiration three inches, and performs its circuit in two minutes. The chief concern of the doctor is the study of this artery, that he may clearly understand, and accurately unfold its manifold meanings; for in so much as he has skill to read its language accurately, by so much is he excellent as a practitioner. From it, besides the temperament of the patient, he deduces the diagnostic character of the disease he is called to treat, after which, having settled the kind and degree of disorder which has arisen among the elements, he sets manfully to work, and boldly promises a cure, knowing, what is not peculiar to China, that the man who promises most in medicine is most followed.

The veins are said to circulate day and night, but it does not appear that they believe the motion to be onward and in a circle : for they say, that having arrived at the end, it again commences where it left off. Nor do they adınit that the arteries and veins have any connection; for they allege that all the arteries and veins have their respective cavities, twelve in all, such as the liver and heart, from which they proceed, and corresponding places where they end; and that, throughout the body, there are paths, ducts, and channels, distinct and appropriate to each, so that the blood does not meet with obstruction in its passage, though why it passes, and by what mechanism, does not appear.

The heart is said to be the ruler, from which the spirits proceed; it is also held to be the receptacle of marrow, which comes from the brain, and goes to the reproductive organs. The lungs are vehicles by which the temper is regulated. The liver holds the place of a general, whence proceeds contrivances and orders. The bile acts as umpire, settling disputed points. The spleen performs the part of messenger, and is the fountain of joy—a function not before ascribed to it, but to which it has as good a title as to be considered the seat of ill-kumour and despondency. The stomach is the granery of the body, and the governor of the five tastes. The great duct is the promoter of principles, and the operator of changes; the smaller ones being the receptacles of superfluity, where digestion is carried on. The kidneys are the rulers of strength, whence all skill proceeds. The bladder, having no connection with the kidneys, is the general reservoir of the absorbents.- Wilson's Med. Notes on China.

Nasty Notices. A foreigner looking over the English newspapers must think the people for whom they are printed, the nastiest on the face of the earth. No language, however gross, indelicate, offensive, or disgusting, is considered unsuited to the eyes polite which scan the contents of the usual channels of information.” At the head of the columns appears the doctor's” book-advertisement on costiveness, with all its evils embellished with words and expressions suited to the subject, and to it alone ; then the instrument-maker's flourish of syringes, operative vases, fountains, and other delicate contrivances; and at the end, the plumber's announcement of water-closets, stationary and portable. This is no fanciful picture. We see it every day. But

« SebelumnyaLanjutkan »