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Brown's cases, therefore, depends upon the amount of confirmatory evidence they bring to show the curability of this long intractable complaint.
Six of the reported cases were treated in St. Mary's Hospital. We select these for analysis. The first case presented an opening the size of an ordinary director close up to the os uteri. It was the result of an instrumental delivery after forty-eight hours' labour. Bozeman's operation was performed On the 15th of October, 1856, a silver button with three holes being used. The patient was reported perfectly cured on the 8th of November.
The next case was admitted in February, 1855. The patient had been delivered by instruments after forty-eight hours' labour in November, 1854. The urine escaped into the vagina twelve days afterwards. There was a large transverse opening across the centre of the bladder, admitting two fingers. Closure appearing impossible, the plan recommended by Jobert was adopted. The neck of the bladder was dissected from the pubis and descending rami, thus allowing the anterior half of the bladder to fall back backwards and relax the fistula. In April the edges were pared and brought together by Sims' method. This did not succeed. The patient left, had another child, and returned in December, 1856. Bozeman's operation was now performed; eight-tenths of the opening were closed. Several successive operations, nine in all, were performed, the last in March, 1858, before a complete closure was effected.
The third case was admitted six weeks after an instrumental delivery. The escape of nrinc was noticed a fortnight after labour. When admitted a large slough was removed from the vagina. The fistula was just anterior to the os uteri, transverse, half an inch long, having a white appearance, showing,that a slough had yet to fall. A month later Bozeman's operation, using a leaden button, was performed. On the tenth day, when the shot and button were removed, the fistulous opening had entirely healed. To facilitate the operation in this case, an incision was made downwards and obliquely to the right side through the posterior wall of the vagina, to enlarge the vulval opening.
The fourth patient was delivered after three days' labour, without instruments. The urine dribbled away two days afterwards. There was a transverse opening about an inch long at the neck of the bladder. The operation was performed on the 19th of May, 1858, using three silver sutures and a leaden button. A second operation was necessary, after which she was discharged, cured, on the 7th of July.
The fifth patient had been delivered after a very protracted labour by craniotomy. The water dribbled away eight days afterwards. The actual cautery had been applied. An opening existed at the upper part of the vagina, close to the right side of the os uteri, admitting the tip of the little finger. The edges were tense and callous. The edges were pared in a longitudinal, instead of a transverse direction. Four silver sutures were passed, one going through the anterior lip of the os uteri. The sutures were removed on the eleventh day, when the opening was found quite closed.
The last case was admitted on the 14th of October, 1857. The patient had been delivered in March by instruments after a protracted labour. She had a fistulous opening into the bladder large enough to admit three fingers; the edges were puckered up, very tense, and the opening was drawn quite behind the arch of the pubis. The urethra and neck of the bladder were first detached from the rami of the pubis, in order to close the opening. On the 17th of December, Bozeman's operation was performed, but unsuccessfully. Re-admitted in January, 1858. The fistula was now an inch and a quarter long, extending in an oblique direction close to the os uteri, which was closed. She had not menstruated since the accident. One of the silver wires used in the former operation was lying bright and firm in the edges of the fistula, causing no inconvenience. The operation now repeated, using seven sutures, was this time successful.
It is clear that no one is likely to have much success in these operations who does not bring as much perseverance as skill to the work.
Art. XI.— On Wounds and Injuries of the Eye. By William White CoorER, Fellow of the Royal College of Surgeons of England, Ophthalmic Surgeon to St, Mary's Hospital, Senior Surgeon to the North London Eye Infirmary, Consulting Surgeon to the School for teaching the Blind, &c.—London, 1859. pp. 380. •
We have received this work at too late a period to allow of our doing more at present than directing the attention of the Profession to it. Without pledging our opinion as to dotails( wu have no hesitation in stating it to be a book of a very practical character, and one that contains a large amount of information on a snbject upon which hitherto we have possessed no English monograph. The volume is profusely and elegantly illustrated, and bids fair to become a favourite with the Profession.
Art. XII.—Summary of New Publications.
The doctrines of the causation and prevention of disease continue to be subjected to scrutiny and illustration by various inquirers, who appear in force during the present quarter, both officially and as volunteers. Drs. Conway Evans and Ii. D. Thomson, respectively, are authors of sanitary reports; the former dealing with the Strand District of London, the latter with the parish of Marylebone. Among the volunteers »e must put prominently Dr. Parkin, because he boldly attacks many of the prevailing theories regarding 'The Causation and Prevention of Disease,' in a work bearing that title. Mr. Smee, in a little book which contains the substance of an oration delivered before the Hunterian Society of London, and is entitled, 'General Debility and Defective Nutrition,'discusses the various influences of civilized life in promoting disease; with it we may mention an elaborate and interesting report of Dr. Whitehead's of the Clinical Hospital, Manchester, which we recommend especially, on account of the suggestive nature of its contents, to those dispensary physicians who wish to utilize their labours for science. Mental Disorders are investigated by Dr. George Robinson, especially with a view to tracing their connexion with the various influences that result from our present state of civilization. In an able review, entitled, 'On the Relation of Psychology and Physiology,' Dr. Harvey warns against the exaggerated importance which he thinks is being attributed to the reflex functions, and asserts the prerogatives of mind as lord paramount of the body, in opposition to those psychologists who would appear to reverse this relation.
General Physiology finds a new exponent in Dr. Dalton, jun., of Philadelphia; Dr. Schiff, whose labours we adverted to in our last number (p. 185), has issued the third number of his 'Lehrbuch der Physiologiein Anatomy, we have to mention a valuable work by Dr. Robert Lee, 'Engravings of the Ganglia and Nerves of the Uterus and Heart, in which we recognise our old friends which illustrated Dr. Lee's contributions to the 'Philosophical Transactions.' We may here advert to an interesting pamphlet by Dr. Harvey, on the Inoculation of the Maternal Organism through the Foetus in Utero. In the sciences ancillary to Medicine, we have to mention Mr. Conington's Handbook and Tables of Chemical Analysis.
In Medicine proper, we have received 'A Handbook of Hospital Practice from Dr. Lyons, which is to serve as an introduction to the ' Practical Study of Medicine at the Bedside.' A fourth edition of Dr. Horace Green's work, 'On Diseases of the Air Passages,' intended, as our readers probably all know by this time, mainly to advocate the local treatment of these affections; and a fifth edition of Dr. Condie's work,' On Diseases of Children,' come to us from the United States, together with the eleventh volume of the 'Transactions of the American Medical Association.' We have before us a comprehensive and elaborate work by Dr. Brinton, 'On Diseases of the Stomach,' and a second edition of Dr. Taylor's well-known work ' On Poisons in relation to Medical Jurisprudence and to Medicine,' containing numerous alterations and additions. Dr. Hunt supplies a volume entitled 'A Manual of the Philosophy of Voice and Speech,' intended to establish the treatment of stammering on a scientific basis; Dr. Mayne progresses laboriously and satisfactorily with his 'Expository Lexicon of Terms in Medical and General Science,' which now attains its eighth number, concluding with strobiliferus. 'The Healing Art the Right Hand of the Church' by Therapeutes; 'Man and his Dwelling Place,' by an anonymous author^ and 'The Soul and Future Life,' by Cromwell, may be mentioned in this place.
Midwifery supplies us with no novelty, unless we reckon as obstetric, Dr. Skinner's 'Chloroform as an Ana3sthetic in Natural Labour Defended.'
Surgery is represented by an American edition, by Dr. Packard, of Malgaigne's 'Treatise on Fractures;' by a prize essay by Mr. Sansom, on 'The Mortality after Operations of Amputation,' to which we have already had occasion to advert in speaking of Mr. Skey's recent work; by the seventh fasciculus of Mr. Maelise's work on 'Dislocations;' by a second edition of Mr. Brodhurst's work, 'On the Treatment of Anchylosis, or the Restoration of Motion in Stiff Joints,' in which the author advocates forcible rupture of the uniting medium in partial anchylosis. We may here also advert to a translation, by Mr. Maunder, of Ricord's 'Lectures on Chancre,' to which, with many of the other works enumerated, we shall refer on a future occasion. We may not, however, close this enumeration without adding Mr. Wilde's 'Medico-legal Observations upon the case of Amos Greenwood, tried at the Liverpool Assizes, December, 1857, for the Murder of Mary Johnson;' the second edition of Mr. Beazley's 'Book of Prescriptions,' the continuation of Dr. Beale's ' Archives of Medicine,' of the 'Ophthalmic Hospital Reports,' of the ' Liverpool Medico-Chirurgical Journal,' and the 'Memorial de Sanidad del Ejercito y Armada,' which we have received from Madrid.
Entoptics. By James Ja-o, A.B. Cantab., M.B. Oxon., Physician to the Royal Cornwall Infirmary.
§ Enloptical Methods and Preliminary Principles.
1. Our visual organs are not only capable, by an adjusting lenticular system, of painting, under varying conditions, images of luminous objects upon a membrane in peculiar relation with the brain, but are furnished with or involve many adjuvant structures. Thus it happens that they reveal to us a number of adventitious phenomena—spectres, as we may call them—whether caused by light at the parts that cover the cornea, or by any stimulus whatever affecting the special nervous tract. Besides the ordinary interest that we feel in tracing subjective illusions to their sources, the accurate elimination of these is a physiological necessity, if we would avoid the risk of ascribing effects begotten by subordinate to more integral portions of the apparatus, and thus of forming wrong conceptions of the laws which regulate the conduct of the latter. Finally, a diligent study of these accidental appearances may be made serviceable for the solution of certain important points of ocular structure of too delicate a nature for the microscope or other usual means of investigation; as also for determining important questions of function.
A methodical proceeding to show, as I have elsewhere expressed it, how "ocular spectres, structures, and functions are mutual exponents," I have here called Entoptics. Or rather, it would be better to regard so much of this essay as deals with phenomena independent of objective light as supplementary, that the word entoptics may accord, as it ordinarily does, with other words from the same root.*
When light is an agent in their production, such apparitions as we allude to arise gencially from certain rays being absolutely or comparatively blocked from the course they would otherwise pursue, or else turned aside by refraction, reflection, or inflection at some object they encounter. But since the pupil is occupied in common by the pencils of rays from all visible points, whilst they again separate as they near the retina, it is only when the phenomena originate far back in the eye that they are discernible in the diffused light of day. Or to view them in other cases, we must regard a bright space of limited extent.
And to make precise observations we should resort to pencils of rays which do not return to foci upon the retina, so that effects once evolved may not afterwards blend with and obliterate one another; as by using rays diverging from some point external to the eye, and within its least focal distance, or rays converging to, and then diverging from some point within the globe.
When a portion of the rays of such a pencil find some body in their path, if a simple shadow is not the consequence, some appearance sufficiently indicative of the body's contour to warrant our currently mentioning it as an image of it, will be projected in the line of the shadow. So that, for the geometrical purpose of discovering the scat of the intervening body—a prominent problem in this essay—we may regard the image as a shadow; as also, with certain precautions, for ascertaining the size of the body. Whilst our ideas of the nature of the body must be derived from a more particular examination of the phenomena it yields under different physical conditions.
2. Draw Ar and c D (Fig. 1), any two straight lines parallel to each other; join A D
and Rc, and through the point E, where the two straight lines thus made intersect cach other, draw Feb perpendicular to A R or c D, meeting them in F and o respectively.
* In 1841, whilst in statu puplllarl, I located mutca volitanta entoptically, and in and out of these T,t others to explore their eyes for me, ere, in 1845, moro leisure led my thoughts into " Points in the PI
jumi «w>ui/l emorace we thought or searching tho eve from known anterior objects back virtually the same as mine, as I find from Helmholtz's sketch of It This paper of Brewster's i i£S°7 nocc,s to ,n ph"- Ma*-. P-1-1848, which introduces It as " from Trans.... vol
18«. l am not within reach of further information about the several dates mentioned. I belle. _
by convergent and divergent pencils to be entirely mine. It may be found in general language in » Ocular Spectra ana Structures as Mutual Exponents," London, January 1, 1856, though it was not then reduced to a geometrical
Again, take some point, E', on the other side of A B, to that where E is situated, join E' A and E' B, and let the straight lines thus made be produced to meet c D, or c D produced, in c' and D' respectively. Lastly, draw B' r' -' at right angles to A B and c D meeting them respectively in F' and o'.
From similar triangles contained in the figure we have c D : A B :: E C : E B, or :: s o: x r; that is, since E -=f O— E F,
CD = AB (— - 5) (a)
In like manner, c'D' : A B :: E' C' : E' A :: E' O' I E' F', and therefore,
CV = AB(— +1) (b)
3. But, firstly, if we view the figure as representing everything as falling in the plane of the paper, we may take A B to be an object lying in the course of a pencil of rays, which converge to the point E, and c D to be its shadow received, under the conditions implied above, after the rays have passed on divergently from E. In the same way c'D' will be a shadow of A B thrown by a pencil of rays diverging from E'.
And we perceive at a glance, that in the former case the shadow is an inverted image, whilst in the latter it is an erect one; that in cither case the length of the shadow varies directly as that of the image. And for a given object the length of the shadow is to its own as their respective distances from the focal point. When the object moves to the focus (e F=o, or, E' F'=o), the shadow is infinite in length; and when to its shadow (f'-'=o), both their lengths are equal. But if we assume the object and shadow to have fixed places, whilst the position of the focus alters (that is, F E or F' E' alone to vary), the equations (a) and (b) show how the approach of the focus to the objection their respective sides of it augments the shadow. That, for instance, (e F=e'f') at equal distances from it, the shadow in the divergent pencil is longer than the other by twice the length of the object. If the focus comes up to the screen on which the shadow is received (e F=f -), there will be no shadow.
Finally, if we know all the terms in either equation, except A B, the length of the object, this may be determined.
4. We may, secondly, regard the same figure as indicating yet other matters. If we imagine a pencil of rays proceeding from left to right to decussate, or pass through a focus at A, and another pencil to do the like at B, C D will represent the distance between the two shadows of any object, E, lying in the divergent portions of the pencils, and c'D' that between the two shadows of any object, E', lying in the convergent portions—that is, if received upon a screen, as implied in the diagram.
Wlierefore, in the first case the objects are inverted in position with respect to the foci; in the other, erect. In either case the distance between the two shadows varies as that between the two foci; and that between the two former is to that between the two latter as their respective distances from the object. Hence, too, if the foci, preserving their distance A B, move, whilst the positions of the object and screen remain the same, the separation of the two shadows is greater when the foci approach the object; when A B arrives at the object, the two shadows are infinitely apart. Should the foci be brought up to the screen, the two shadows would be at their distance (a B) from each other. But if we assume the foci to be fixed as well as the screen, whilst the object changes its place (f E and F' E' alone to vary), the equations (a) and (b) show how the approach of the object to the foci, and their respective sides, augments the separation of the pair of the shadows; and that if Ef = E' F', the distance between the pair in the convergent pencil is greater than that between the pair in the divergent by twice that between the foci. If the object touch the screen (e F-fb), the two shadows coalesce. But if E' F'=f' -', the two shadows are twice as widely sundered as the foci.
Finally, if we know_all the terms in equations (a) and (b), except E F or E' F', the place of the object, this may be determined.
5. It being proposed to make the principles above explained the fundamental method