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suming, on her own calculations, that she had not arrived at her full period of gestation, I took from the arm Zxx. of blood, and gave Tinct. acetatis opii gutt. xxx. She was much relieved, and continued comparatively easy for several days, but the annoying pains returned, and continued with more or less severity up to the time of her accouchement,
On the 19th of November, at 6 o'clock, A. M., I was summoned to visit Mrs. W. in haste. On entering her apartment I found her in strong lahour, and on making an examination per os externum, I discovered a fulness with great tension and pressing down of the smooth fibrous structure blocking up the vagina; and this condition of the parts increased on the return of every succeeding pain, till in the space of two hours I could perceive evident fluctuation of the waters within the membranes, and by forcible pressure with the fingers could feel a hard body low down in the pelvis, which I supposed was the head of the child.
Not feeling disposed to assume the entire responsibility of this extraordinary case, and besides desiring to afford the professional gentlemen who had previously examined the condition of this wornan, Drs. Barnes and Campbell, an opportunity of wituessing the issue of the case, they were ordered to be sent for. In the mean time the parturient pains continuing with powerful force, the patient was placed on her back, with the thighs separated, and opening the Jabia-externa with the thumb and fingers of the left hand, I carefully divided the integuments with the scalpel to the extent of one inch, commencing the incision at the most prominent part of the tumour, and on a direct line from the orifice of the urethra to the perineum. The structure divided was about three-fourths of an inch in thickness, and of a firm fibrous texture, clearly indicating that the occlusion was not the result of simple adhesion of the sides of the vagina, but the new formation of tendinous tissue. Whether the membranes containing the liquor amnii had previously ruptured, or whether they were punctured with the point of the scalpel, it is impossible for me to know; at any rate, on passing through the structure with the knife, there was a free jet aud flow of water for a moment, and also considerable hemorrhage, but this was not to an alarming extent, having its source principally in the great vascu. larity of the parts surrounding and closing the vagina.
I was now able to ascertain the condition of the os uterifound it dilated to the size of a twenty-five cent piece, the margin thin and of a natural feel, with the head of the child presenting. By this time Dr. Campbell arrived, (Dr. Barnes not having received the notice,) when we dilated the incision previously made to the extent of two inches, by carefully dividing fibre by fibre, with a well giarded probe.pointed bistoury, cutting both anteriorly and posteriorly. The pains continued with wonderful force, and the os uteri dilating, we soon were able to perceive the hairy scalp of the child, and ascertain more clearly its position, which was the posterior fontanelle to the symphysis pubis. The soft parts readily and safely dilated as the head advanced ; and although the labour was both tedious and laborious, until the head emerged from the inferior strait of the pelvis, not an untoward event occurred, and the woman was safely delivered at five o'clock, P. M. sarne day, of a well formed and living female child, weighing 8 pounds. At this date (January 2d, 1847) both mother and child are living and doing well, and the poor woman feels doubly compensated for all her past afflictions, by the entire removal of her physical impotency, and the new source of moral happiness which has been lighted up on becoming a mother.
It may be proper to add, that great care was paid to the subsequent management of this case, and by means of a tent and other necessary applications, the newly formed vagina has been maintained. Suppuration has entirely ceased, and new mucous tissue partially formed on the internal sides of the divided structure.
The physiological questions involved in this case are-how did the menstrual fluid make its exit from the uterus, and by what law of the animal economy did conception take place? The woman's own statement, (her husband also concurring in the same facts) was, that since recovery from her long confinement in 1844, which was about the end of November of that year, her condition had been at no time different from what it was at my first and subsequent examinations; yet, notwithstanding, she menstruated regularly up to the middle of February, and at that time was as much unwell as usual.
She could give no account of it, except that the discharge issued from between the labia externa was small in quantity, continued about three days, and during these periods she never experienced any pain or difficulty whatever. Here I must express another regret-that in the investigation of this case, I never had an opportunity of observing the appearance of the parts during menstruation, which at the time I made my first examination it was my settled purpose to do at the next or some period of their flow, not having the most distant idea that preg. nancy was the cause of their supppression.
Was there a vicarious secretion from the inner surface of the labia pudendi and contiguous parts, or did the menstrual fluid permeate through the fibrous structure blocking up the vagina? I am inclined to adopt the latter opinion, although we were unable, on the minutest examination, to detect that condition of the surface which such a process would indicate.
In contemplating the curious phenomenon of conception in this case, I find on the very outset of the inquiry, the physiological views I had long entertained on the subject are subverted, and not feeling prepared to attempt an elucidation of that wonderful and mysterious function of organic life-conceptionon any other principle than that of the actual presence of the semen masculinum within the cavity of the uterus, I will submit the rationale of this singular case to those who are deeper read in nature's laws, and whose province it is to demonstrate the occult mysteries in physiological science.
Saint Louis, Mo., January 2d, 1847.
Extraction of a large stone by the lateral operation. By R.
HAYWOOD, M. D. of Tuscaloosa, Alabama, (communicated in a letter to Professor Pancoast.)
DEAR SIR:- I take pleasure in reporting to you another operation of Lithotomy which I have performed successfully. ****
I was consulted by Mr. Armstead, of Tuscaloosa county, thirteen miles from this place, in a case of stone in his son, that had manifested unequivocal signs of its existence from birth. I sounded him and found a calculus of large size. I prepared him for an operation as soon as the condition of his case would permit, his health having suffered greatly from the presence of this foreign body in the bladder, until he was in his thirteenth year. As soon as the necessary preparation was made I performed the lateral operation, and extracted a stone weighing 1 oz.5dr. 16 grs.
I should have completed the whole operation in six minutes, had it not been that the shape of the stone was oblong, and I seized it first in its longitudinal diameter. I changed the forceps, and then seized it by its transverse diameter and extracted it.
In five weeks from the operation I sent the boy home, perfectly well. His health is now good, and he is daily improving in strength.
I send you enclosed an analysis of the stone and its weight, shape, size, appearance, &c., by Professor Brumby of the University of Alabama, (a gentleman highly distinguished in our state,) which you will be much gratified to examine.
University of Alabama, September 23d, 1846. Dr. R. Haywood.
DEAR SIR: I have made a careful chemical examination of the calculus, which you gave me for the purpose on the 21st inst.
It was the largest I ever saw; weighed 653.70 grs., Troy, though three small fragments had been detached from it, while in your possession ; was oblong-oval in form, slightly flattened ; in colour yellowish-brown externally, white, with a tinge of yellow internally; its surface presented very distinct tubercles, and was coated with small, white, shining crystals. It was solid, compact, brittle, and easily cut or scraped with a knife; and when divided by a very fine saw, in the direction of the larger diagonal, its structure was beautifully displayed, showing a series of concentric coats, that diminished in hardness to the small, pulverulent, central nucleus.
Thongh only partially soluble in cold, it softened readily in hot water, and formed a white gelatinonis mass, which subsided as the water cooled. In a solution, cold or hot, of pure potassa, it was insoluble ; but it dissolved readily in dilute nitric, sulphuric, hydrochloric, and acetic acids. From these acid solutions, it was readily precipitated by excess of pure potassa or soda with the evolution of a urinous, ammoniacal odour. A few drops of ammoniacal nitrate of silver being added to a neutral solution of it in nitric acid, the peculiar colour of phosphate of silver instantly appeared. A fragment heated to redness in a small platinum crucible first turned black, then became white, and was neither consumed nor fused; and, eveu before the blowpipe, the white residue was fused without difficulty. I was unable, by the most careful experiments, to detect the presence of uric acid, in any sensible quantity.
You will perceive, from these results, that it must belong to the species denominated by chemists ammoniaco-inagnesian phosphate or triple calculus. This species is rarely pure, but generally contains a mixture of phosphate of lime. I did not deem it necessary to investigate this point, as its determination would not have any influence on your treatment of your patient.
Yours most respectfully,
R. T. BRUMBY.
Report of HENRY T. CHILD, M. D., Vaccine Physician for the
Northern District of the Northern Liberties of Philadelphia. To the Board of Commissioners of the Northern Liberties.
GENTLEMEN :-During the quarter ending on the first inst., I vaccinated eighty-one persons, twenty-nine of whom were males, and fifty two were females, which, together with four hundred and forty cases previously reported, makes a total of five hundred and iwenty-one cases for the year 1846.
During the last three months I have found that a large number
persons were insusceptible to the vaccine disease, when vaccinated under the most favourable circumstances, probably owing to the fact that we have no epidemic small pox influence in our midst.
In a former report, I remarked that previous to the existence of the epidemic, which was then prevailing, the failures among the first vaccinations were about ten per cent, but at that time they were not more than two per cent. After the disappearance of the epidemic the proportion of failures began to increase, and at present they are over thirty per cent, although the insertion of the virus, (known by its effect on others to be good,) has been repeated several times. I believe it is a fact that in those countries where small pox has never prevailed, vaccination can not be successfully performed, and I am inclined to the opinion that when there is no epidemic small pox existing, many persons will not receive the genuine vaccine disease; hence they will not be properly protected, and when exposed to the influence of smallpox, may be infected with varioloidor the disease in a modified form, and therefore I repeat my conviction as expressed in a former report,“that re-vaccination is necessary, during the existence of epidemic small pox, as a test of the protection of the system.” All of which is respectfully submitted.
HENRY T. CHILD. No. 132 Green street, N. L., 1st mo. 4th, 1847.