« AnteriorContinuar »
consequent longer duration of labour, is even less than has often been observed.
Table VI. (p. 43), which shows the varieties of labour in 22,498 confinements, is worthy of attention. We find that perforation of the child's head was had recourse to in eighty-two cases, while Cæsarean section was performed twice. In one case of Cæsarean section, both mother and child died ; in the other, both survived.
Seven cases of rupture of the uterus occurred during the twenty-one years, all fatal.
Twenty-seven cases of puerperal convulsions are reported. In twenty-one of these cases, the urine was examined, and, with one exception, found to be albuminous, the convulsions in the exceptional case depending on arachnitis. The coincidence of albuminuria and puerperal convulsions was, we believe, first pointed out by Dr. Simpson in 1841; and the recent researches of Frerichs and Braun leave little doubt, that all cases of true eclampsia result from uræmia in the course of acute Bright's disease.
The total number of deaths of mothers was 160, or I in 140.
In one case labour occurred (the uterus acting “powerfully”) in a woman affected with perfect hemiplegia and incomplete paralysis of the other side. Such cases disprove the doctrine of Marshall Hall and others, that uterine action is dependent on spinal influence, and tend to show, as urged by Drs. Simpson and Lee, that it is rather of a reflex ganglionic nature. Dr. Simpson's view is also confirmed by his observation of contractility remaining in the uterus of the pig, twelve hours after removal from the body.
III. Select Cases. By H. M. HUGHES, M.D.-The first of these cases is one in which the urine assumed a brownish-black colour while the patient was taking creosote. There was no deposit on standing, and nothing revealed by microscopic examination. The colour was unaltered by heat, nitric acid, or liquor potassæ, even when boiled with it. Similar cases are stated to have been observed by Drs. McLeod, Marcet, and Elliotson ; and Dr. H. Weber has recently ascertained that the inunction of tar produces occasionally the same result. Dr. Hughes confesses his inability to give any explanation of this curious and rare consequence of the use of creosote.
Dr. Hughes also records a case of intussusception, in which “the whole ascending colon, the cæcum, and an unascertained portion of the ileum, had passed into the transverse and descending colon and rectum;" and another of emphysema of the abdominal parietes, proceeding from perforation of the rectum by the careless introduction of an enema tube.
IV. On Hernia; with an Analysis of 126 Fatal Cases. By THOMAS BRYANT. — The author commences his observations by answering the questions, “What form of hernia is most common? what form most frequently requires operation ? and which is most fatal ?" This he does by appealing to the statistics of the London
Truss Society. Of 84,478 cases of hernia, 88.8 per cent. were inguinal and 11.1 femoral. Of 281 cases requiring operation, the femoral exceeded the inguinal by 25-2 per cent.; and of 169 cures after operation, inguinal bore the proportion to femoral of 36:1 to 63.8.
In the analysis of 126 fatal cases, numerous tables are given, the chief results of which are contained in the following important “conclusions :"
“Inguinal hernia is more common than femoral, commences earlier in life, is less liable to strangulation on its first descent, and generally exists twenty years before it becomes so; requires operation less frequently, but is more fatal; is less frequently associated with gangrenous bowel, but more frequently with ulceration at the line of stricture.
« Femoral hernia is less common than inguinal, seldom appearing before fifty years of age; is more frequently strangulated on its first descent, but generally averages eleven years' existence; more frequently requires operation, but is less fatal; and is generally strangulated for a longer period before relieved. After operation, femoral hernia is more frequently followed by sinking than inguinal."
V. On Concealed Accidental Uterine Hæmorrhage. By HENRY OLDHAM, M.D.-Dr. Oldham's paper contains a notice of four cases of accidental hæmorrhage, in which the blood was retained within the womb, little or none escaping externally. The rarity of the accident is shown by only three cases occurring out of 22,498 deliveries at Guy's Lying-in Charity. All of these three were fatal. The fourth case recorded—that of a lady-recovered.
VI. Cases of Lardaceous Diseases, and some Allied Affections ; with Remarks. By S. WILKS, M.D.-Under the term “Lardaceous," the author has described those affections of the liver, spleen, and kidneys, which in this country more commonly are known under the designation of Waxy. Forty-five cases of the disease are recorded in the paper.
This affection has been, and is still, very generally confounded with Fatty Degeneration, and even Rokitansky has described them as mere varieties of the same disease. The points of distinction, as regards the liver, were described by Dr. W. T. Gairdner, of Edinburgh, in a valuable paper, published in the · Edinburgh Medical Journal' for May, 1854; the characters of waxy disease being great density, no increase of oily matter, but a substitution for the natural secreting tissue of a dense albuminous material: whereas in fatty degeneration the specific gravity is reduced, and a large quantity of oil is deposited in the cells of the normal tissues.
Dr. Wilks's description of the structural peculiarities of this lesion bears a very close resemblance to that which was laid before the Physiological Society of Edinburgh by Drs. Gairdner and Sanders, in 1854,* and we are somewhat surprised to find no allusion whatever made to their valuable researches.
• Monthly Journal of Medical Science, vol. i. pp. 186, 393. 1854.
The clinical distinctions between waxy and fatty kidney have been lately made a subject of observation by Dr. Todd.*
Dr. Wilks has observed a curious connexion between waxy disease and disease of the bones. Thus, “out of thirty-six cases of lardaceous viscera, sixteen had necrosed bone, and eleven very evident disease of a syphilitic or other affection of the osseous system.”
VII. Report of the Post-mortem E.camination of the Cases of Burn occurring during the last Year and a half, with reference to the Condition of the Duodenum. By S. WILKS, M.D.-Dr. Wilks brings forward twelve cases of burn, proving fatal after the third day, and " in no case was there any disease discoverable in the duodenum." These observations are opposed to those of Mr. Curling, who, in the twenty-fifth volume of the Medico-Chirurgical Transactions,' recorded twelve fatal cases of burn, in all of which there was either inflammation or ulceration of the duodenum, as evidenced by inspection after death, and vomiting and purging of blood during life. The cause of this difference as to facts, it is endeavoured to explain, by the practice of giving children ardent spirits immediately after the receipt of burns being now obsolete.
VIII. Brief Report of the Post-mortem Examinations of the Cases of Ferer which hare Died in the Hospital during the last two Years. By S. WILKS, M.D.-As we have already had occasion to notice, + Dr. Wilks fully recognises the distinction between the two forms of fever, typhus and typhoid, in the cases occurring at Guy's Hospital. The only observation in the present paper to which we shall allude is this, in reference to typhoid fever:
"In three of the present cases, howerer, where the disease was not quite advanced to its height, some remarkable microscopical bodies were found. These consisted of rounded cells, containing numerous nuclei, which amounted in some to ten in number. They were found equally in the deposit of Peyer's patches and mesenteric glands.*
These alls have been described and figured by Vogel, Wedl, and others and the reason ther have so seldom been recognised is, according to Well, that they use to be distinguishable on the establishment of uleration. It is still doubtful if they are characteristic of typhoid deposits
IX Players Pioneria Br nuAX GEL, M.D.—This paper contains the history of sixteen cases of paraplegis In three cases the
pleine ley ended on tumours powing on the cond; in two of the that there werwin in the back. and involuntary muscular contractrous of the para red limbs In one, both these symptoms were
here; in this there was also considerable softening of the cord. In the abilir was either inanador umaffected; in one,
the most ammation of the spinal membranes was the tonalixtus Na
r s en 1937.
lesion, but in one of these cases the only paraplegic symptoms consisted in paralysis of the bladder and rectum. In four of the five cases, pain in the back was a prominent symptom; in one it was absent. In three out of four cases, there were involuntary spasmodic movements of the lower limbs; and in the fourth, though these were absent, there were “convulsive movements of the hands.” In two cases, there were contraction and rigidity of the lower limbs, the heels in one being drawn up to the nates. In three cases, the sensibility was increased; in one, diminished ; in one, completely absent; but in the two last cases, there was also softening of the spinal cord. In one instance paralysis of the upper extremities preceded that of the lower for some months.
In four cases, softening of the cord appeared the principal lesion. In three of these, pain in the back was either absent, or not a prominent symptom; in one it was severe, and in this case only was there also inflammation of the membranes; in two, involuntary movements were either absent or not mentioned ; in one, slight; and in one, severe: in this last, there was also inflammation of the membranes. In all four cases, there was more or less anasthæsia.
In the remaining four cases, the paraplegia was produced by effusion into the membranes, with slight softening, lead poisoning (?), tumours in the substance of the cord, and enlargement with induration of the cervical portion.
From the above cases it would appear, that pain in the back, and involuntary movements of the paralysed limbs, are more common symptoms in affections of the membranes than in softening of the cord, and anasthæsia a less frequent one.
X. On the Parasitical Vegetable Nature of Pityriasis Versicolor. By W. GULL, M.D.—The author confirms the observations of Eichstedt on the dependence of pityriasis versicolor on the presence of a fungoid growth (Microsporon furfur), and gives a figure showing its appearance under the microscope.
XI. Some Observations on the Abdominal Sympathetic Nerve, and on the Union of the Phrenic and Pneumogastric Nerves. By S. O. HABERSHON, M.D.-The most important of these observations is the description of a ganglion, called the “ diaphragmatic," situated behind the lobus Spigelii of the liver, close to the vena cava, and formed by the union of branches from the phrenic and pneumogastric nerves and semilunar ganglion.
“ The use of the diaphragmatic ganglion appears to be to bring the diaphragm into intimate relation in its action with the abdominal viscera, and to unite the digestive and respiratory and cardiac centres of the sympathetic nerve.” Various sympathetic phenomena are mentioned, to the production of which this ganglion may be subservient.
XII. On Dysphagia, illustrated by some cases of Disease of the Esophagus and Pharynx. By S. O. HABERSHON, M.D.-The principal causes of dysphagia are stated to be as follows:
«I. From the disease of the tonsils or palate.
“II. From inflammation of the cellular tissue of the pharynx or msophagus.
"III. From disease of the laryngeal cartilages or epiglottis.
“IV. From functional or spasmodic stricture of the csophagus or pharynx, as in hysteria, hydrophobia, &c.
“V. From paralysis of the muscles.
“VIII. From structural obstruction to the wesophagus, as-1. constrictions; 2. ulcerations ; 3. cancerous disease; and 4. aneurismal or other tumours.” Cases illustrative of most of these forms are brought forward ; and among these, are several in which a communication was established between the csophagus and air-passages, either by simple or cancerous ulceration.
XIII. On the Use of Atropine in Iritis. By JOHN F. FRANCE.— Mr. France advocates strongly the use of belladonna, or atropine, throughout every stage of iritis.
XIV. Ophthalmic Cases. By John F. FRANCE:—These are two cases of artificial pupil brought to a successful termination.
XV. On the Alkaline Emanations from Sewers and Cesspools. By WILLIAM ODLING, M.B., F.C.S.-Dr. Odling has obtained evidence of the existence in the liquid contents of cesspools, of a base, approaching very closely in composition to that of ethylamine (C, H, N); but as yet, he is unable to say whether it “is or is not the toxic ingredient of sewer exhalations."
XVI. On the Detection of Antimony for Medico-Legal Purposes. By W. ODLING, M.B., F.C.S.--Dr. Odling's valuable researches show, that Reinsch's test for the detection of antimony, in which the metal is deposited on a copper plate, is the most delicate which we possess. The trial of “Regina v. Palmer" was the first criminal case on record in which this process was employed for the separation of the poison. The details of the process are given, by which it appears that one part of tartar emetic in 500,000 of dilute hydrochloric acid will produce a “ decided and characteristic deposit” on a square inch of copper plate. The precipitation of other metals under the same circumstances is also considered ; and it is shown that several others, more especially bismuth and tin, may be confounded with antimony. Consequently, the separated metal must be subjected to additional tests; and, as Dr. Odling observes, we require “ some means for dissolving metallic antimony, having no solvent action upon metallic copper." None of the means previously resorted to effected a complete and easy isolation of the antimony, and hence Reinsch's test was seldom employed. The process, however, recommended by Dr. Odling leaves nothing to be desired.