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Members present: Drs. G. A. J. Mayfield, Robert Martin, Thog. Buchanan, G. W. Currey, T. L. Maddin, G. B. Smith, Woodward, Callender, and Compton.
The Secretary read the minutes of the September meeting, which were approved.
Dr. W. Nichol was elected a member of the Society.
The chairman called upon Dr. G. A. J. Mayfield, who had been appointed at the last meeting to draw up a report on the state of the health of the city, to read his report.
Dr. G. A. J. Mayfield stated that he had not considered it necessary to draw up any written report, as the city had been uncommonly healthy, and no epidemic whatever had visited it. He begged therefore to be excused. On motion, this was granted.
Dr. Robert Martin presented the Society with the following report of a case of Placenta Prævia, which was read by the Secretary:
REPORT OF A CASE OF PLACENTA PRÆVIA.
To the President and Members of the Nashville Medical Society :
GENTLEMEN :- At your solicitation the following case has been drawn up, and is now at your disposal :
Mrs. C. H., after having undergone, from the early part of November, 1857, to the 20th of February, 1858, all the physical exertion and mental anxiety pertaining to the faithful caring-for of her husband in his last and protracted illness, with but little assistance, was awaked a little before three o'clock A. M., June 19th, by a sense of pelvic uneasiness, and consciousness of a discharge, as she supposed, from the bladder, but on rising from bed ascertained that it was blood, which increased so rapidly as to cause alarm and urgent indications of syncope.
Having been promptly summoned, I saw her about daylight in the condition now to be described : Flooding continuous, great anxiety, skin cold, shrunken, and wet, pulse only perceptible, no pain, but an indefinable uneasiness pervading the abdomen. By the touch the os uteri was found to be partially dilated and seemingly dilatable. The existence of placenta prævia was now ascertained, and the fact that it was incomplete was also noticed, as on the right margin the membranes were reached and ruptured without delay, maintaining the finger in the rent with the twofold intention of promoting the escape of the liquor amnii and irritating the os uteri, thus essaying to rouse uterine contraction. The hand of the infant was felt, and some form of malpresentation was now among the probable necessities of the case. It therefore became a question, How far shall this liability to a troublesome complication modify the management of the case? Believing that the existing uterine inertia was one of the most prominent of the train of circumstances jeopardizing the life of my patient, I therefore, with the view of more fully bringing to bear the influence of irritation of the os uteri, and to forestall the probably not very remote embarrassments consequent upon an unnatural presentation, and also to avail myself of the agency the movements involved in, and the change of relations resulting from, version, might induce for the production of labor-pains, resolved, by gentle, firm, and continuous efforts at dilatation, to introduce so much of the hand as might be necessary to reach the feet and bring them down. In executing this design, the mouth of the womb proved to be much less yielding than was anticipated; yet, after a protracted struggle, one foot was finally secured by the introduction of the fingers only, and was easily brought down, the evidence being now satisfactory that version had been accomplished. At this juncture, having previously lowered the patient's head, and given brandy and spirits of turpentine to relieve the urgent prostration, it was deemed advisable to rely at least for a time upon the inherent energies of her system, (originally good,) with the vantage-ground secured by the draining off more or less completely of the waters, and the altered relations secured by version; and, much to my satisfaction, though there was no felt pain, yet tonic rigidity was developed so as to arrest the further loss of blood.
The labor was not announced until after five o'clock P. M., nor was it completed till after seven o'clock P. M. The child was dead. Owing to previous exposure and great loss of blood, her recovery was retarded, but was finally successful.
On the motion of Dr. Callender, the thanks of the Society were tendered to Dr. Martin, and the report ordered to be printed among the Transactions.
Dr. Maddin introduced the following resolution :
Seeing that, in the preparation of the monthly report on the health of the city, the compiler has at first considerable difficulty in getting the required information, which afterwards is made easier by experience, and therefore that it is injudicious in the Society to appoint each month an officer who has first to learn his duties; be it
Resolved, That the office of Health Reporter be intrusted to a physician for a period of three or six months, he being required to produce a report at each monthly meeting during the time of his holding office.
This having been seconded, was carried; and the chairman, considering the efficient manner in which Dr. Lewis had prepared the report for September, appointed him to report for the next three months.
The Society then adjourned to meet at the office of Drs. Foster and Blackie, over the Bank of Nashville, on the first Wednesday in November.
S. S. MAYFIELD, M. D., Vice-Pres't. GEO. S. BLACKIE, M. D., Sec'y.
From the Medical Times and Gazette (London) for Aug. 7, 1858.
STOMACH DISORDERS CONNECTED WITH TUBERCULAR DISEASE OF
A CLINICAL LECTURE BY GEORGE BUDD, M. D., F. R. S.
IF, at any time, you will direct your attention to the cases of tubercular disease of the lung under treatment in the Hospital, you will remark that in the greater number of them the functions of the stomach are more or less disordered. Some patients complain of loss of appetite; others of pain after food; but the most common disorder is vomiting, which occurs, indeed, so generally, that it may almost be regarded as one of the symptoms of phthisis. Sometimes the matter vomited consists merely of the food recently eaten ; but very commonly it contains a large amount of free acid, and is very sour.
As a general rule, this gastric disorder is much more severe in women than in men.
At the present time there are in the Hospital two cases of phthisis under my care in the men's wards. The first, that of Jeremiah Hurley, aged 32, who was admitted on January 2. He appears to have been ill about eight months, and has now most of the symptoms of confirmed consumption-much emaciation; cough, with expectoration of puriform matter; and the physical signs of extensive tubercular disease in the upper part of the right lung. In this case there has been very little vomiting or other evidence of stomach disorder. The second case is that of James Prendergast, a laboring man, 45 years of age, who was brought into the Hospital on October 31 with profuse hæmoptysis. He continued to spit up large quantities of blood for several days after his admission; the hæmoptysis then ceased, but a harassing cough continued. Three weeks ago, he began to be much troubled by vomiting, and the matters rejected by vomiting were often very sour. Hydrocyanic acid and a light diet were prescribed, and under the influence of this the stomach disorder appears to have ceased.
In the women's ward, under my care, there are three cases of phthisis. The first is that of Mary Adams, admitted January 6, a woman 36 years
of age, pallid, and much emaciated, with marked symptoms of advanced phthisis. She states that she has been ill five months, and from the beginning of her illness has been much troubled with vomiting, which occurred at the end of fits of cough. What she vomits is usually very sour. About a month before her admission, she vomited a large quantity of matter as black as ink-apparently blood, blackened by the acid secretions of the stomach. There was, she states, nothing amiss with her stomach before the cough came on. The second case is that of Sarah Page, who has been in the Hospital since the beginning of October, with extensive tubercular disease of the left lung. She has occasional vomiting, when the cough is troublesome, but what she brings up is usually not sour. Her chief complaint now is of pain in the stomach, which comes on directly after eating, and is so severe that she almost declines to take food. The food does not cause vomiting except during hard fits of cough.
The third case is that of Ellen Leonards, a woman of the age of 30, who was admitted Jan. 3. She has been troubled with cough for the last six months, and has the physical signs of phthisis. In this case there has been much vomiting, which at first occurred after fits of cough, and never at other times. What she vomits is often sour.
At almost any time, among the patients in the Hospital affected with phthisis, you may find instances of stomach disorder somewhat similar to those to which I have just called your attention ; and it is, I need hardly say, very important to remedy these stomach disorders, because they interfere very much with the nutrition of the patient, already reduced by other causes of exhaustion.
In persons dead of phthisis, it is seldom that the stomach is found in a perfectly normal condition; but the changes it has undergone are very various.
Occasionally it is greatly enlarged. This condition is dependent on fatty enlargement of the liver. The large liver overlaps and compresses the pyloric end of the stomach, and thus prevents it, like a stricture of the pylorus, from readily and completely emptying itself through the pyloric orifice. Enlargement of the stomach exists only in cases in which the liver is fatty; and it is much more common in women than in men, because in women fatty enlargement of the liver much more frequently occurs.
The most common abnormal condition of the stomach in persons dead of phthisis, is a softening of its mucous membrane, caused, after death, by the action of the gastric juice. This change is most common in the big end of the stomach, where, after death, the liquid within it chiefly collects. The change may consist merely in slight gelatinizing and softening of the mucous membrane, so that it can be more readily scraped away; or the membrane may be in places entirely dissolved, when the vessels that ramify beneath it come into view, blackened by the action of the gastric acid on the blood they contain. In some rare instances all the coats of the stomach are dissolved in succession, and its contents escape into the peritoneal sac. These changes are more commonly met with in summer than in win.
ter; because, the higher the temperature, the more rapidly the postmortem digestion proceeds. Occasionally, in the stomach of a person dead of phthisis, marks of inflammation are found. The mucous membrane is thickened in places, and more vascular than usual, and often coated by viscid adhering mucus.
Sometimes in these cases very
minute superficial ulcers of the mucous membrane are seen, and in such instances there has often been during life some traces of blood in the matters vomited.
The functions of the stomach are, no doubt, in some degree disordered in phthisis by the fever and the constitutional disturbance that so commonly exists; but the gastric symptoms and the various abnormal appearances of the stomach found after death in the subjects of this disease, appear to be owing in great measure to a reflex disturbance of the stomach, excited by irritation in the lung.
Tubercular disease of the lung, and the inflammation it sets up, by irritation of the filaments of the pulmonary nerves, cause not only cough but reflex nervous disorder of the stomach, of which vomiting at the end of a fit of cough is commonly the first symptom. A similar extension of the spasmodic act occurs in hooping-cough, where the paroxysm of cough frequently terminates in vomiting. Vomitiny is often excited in the same way—that is, by a reflected nervous ivfluence-by causes of disturbance in other parts of the body. It is a common effect of inflammation of the brain, and occurs almost constantly during the passage of gall-stones through the gall-duets, and during the passage of a urinary calculus from the kidney to the bladder.
In phthisis, the irritation of the lung on which the vomiting primarily depends is persistent, and consequently the stomach disorder is persistent, or very apt to recur.
Vomiting occurs more frequently, and other gastric disorder is more common in women than in men, because the nervous systems of women are more susceptible, and reflex nervous disorder of any kind is more readily excited by a given disturbance in them.
In some cases of phthisis, the mere mechavical act of vomiting is excited : there is mere vomiting of food, or, if the stomach happen to be empty, dry retching.
In other cases, the secreting apparatus of the stomach is excited by a reflex nervous influence to pour out large quantities of gastric acid, and much sour fluid is ejected from it.
in the same way, inflammation of the brain, or the passage of a gallstone, not only excites the mechanical act of vomiting, but also, in some cases, a great outpouring of gastric acid.
By untimely secretion and waste of gastric juice the power of the stomach is exhausted; and when food is subsequently taken before this power has been restored, there is an insufficient secretion of the solvent juice, and digestion is slow and imperfect. The food, when it has remained undigested a certain time, irritates the mucous membrane, renders the stomach tender and painful, and causes, by the frequent repetition of the same process, the inflammatory appearances which the lining membrane after death sometimes presents.