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mula in cases in which phosphate of lime is indicated :—Calcis phosphat. Sij.; Calcis carbon. Si.; Sacch. lactis, Siij.; M. 3ss. bis terve in die. InsteaJ of the milk sugar, lactate of iron may be substituted, if iron be requir-i The especial use of the carbonate of lime appears to be that carbonic acid u liberated by the acid of the stomach, and dissolves the phosphate. Lactic acid also is formed from the sugar, or is set free from the lactate of iron, and dissolves the phosphate. The most ready way of absorption is, however, whea the phosphate is given with food, especially with milk, with which it forms ■ soluble combination.—Schmidts Jahrb.
VII. Uva Ijrsi Instead Of Ergot Of Rye.—Mr Harris relates cases in which he has employed a strong decoction of uva ursi in accouchmenta, where the ergot of rye would ordinarily have been employed,and found its employment followed by vigorous pains, which soon caused the expulsion of both foetus and placenta. Mr Harris prefers this medicine to ergot of rye, inasmuch as it does not cause such strong contractions as the latter, which are so very painful to the mother and dangerous to the child.— Virginia Medical Journal.
EDINBURGH OBSTETRICAL SOCIETY.
RECENT VIEWS IN EMBRYOLOGY.
Dr Simpson made a lengthened communication on the more recent view§ on embryology, and exhibited a very beautiful and extensive series of illustrative casts, models, and drawings.
CASE OF FATAL ACCIDENTAL HEMORRHAGE.
Dr Simpson exhibited the uterus and contents removed from a woman who had died, pregnant with twins at about the sixth month, from hemorrhage.
Dr Gordon, in whose practice the case occurred, mentioned the particulars of the case, and stated that during all her previous pregnancies, the patient had been subject to floodings.
Dr Thomson corroborated Dr Gordon's statement.
Dr Simpson made some remarks on the preparation, and exhibited a drawing of the parts as first observed.
ON TUB STATE OF THE FOETAL PULSE AS AN INDICATION FOR ARTIFICIAL
Dr Simpson made some remarks on the indications afforded by the stethoscope for expediting delivery, and specially directed the attention of the Society to the fact, that while danger was usually indicated to the mother during labour, by the increased rapidity of her pulse, the death of the child was most frequently threatened when the festal pulse became slower and slower. It was known that in cases where, during labour, pressure was exercised upon the cord, the pulsations of the foetal heart became feebler, and were at length suspended by the continuous pressure. This was most probably the way in which the foetus perished, during severe and prolonged dabours; the aeration of the blood by the placenta being imperfect, or entirely suspended. There were, however, cases in which danger was indicated to the child, by the foatal pulse becoming; much more rapid than ordinary, reaching 150 or 160 beats in the minute, and
at the same time very irregular. Dr S. believed the danger in these cases did not result from pressure on the umbilical cord, as in the cases where the pulsations became slower and slower, but from pressure or some source of irritation acting on the brain.
PRESENTATION OF CORD.
A conversation took place on this subject, and cases illustrating the different and most successful modes of treatment were referred to by various members.
Dr Keiller stated that he had lately witnessed a case of cord presenting with the head, and that he had succeeded in reducing the loop, and supporting it above tbe brim for two hours, by introducing his hand into the vagina, and which, he stated, the free use of chloroform enabled him to do. The child however, was still-born, apparently from a secondary compression by the shoulders or other parts, after the head had passed through the brim. Dr K. mentioned another case somewhat similar to the above, but in which the child was saved, the cord being reduced by the hand after having failed with the catheter. Dr Keith having also tried the method of reduction by the catheter in this case.
ON TUB MAMMARY TREATMENT OP AMENNOBRHEAL CASES. BY DR KEILLER.
Dr Keiller directed the attention of the society to tbe treatment of amennorrhea by mammary irritation, and referred to several cases which he thought he had recently cured by this method. Dr K. remarked that our knowledge of the active sympathetic relations existing between the mammary glands in the female and the other more direetly sexual organs, first gave rise to the idea that an irritation set up in the former might be advantageously communicated to the latter, and this idea of stimulating the uterine system into increased action, by irritating those parts of the body which, although apparently unconnected, are yet intimately related, has not only been long entertained but often acted upon, with the view not only of stimulating the uterine organs in amennorrheal cases, but of exciting premature labour and checking haemorrhage, by sympathetically inducing the uterus to contract. The modes of applying this indirect kind of irritation to the uterine organs are either superficial or deep, or both combined (which latter method was that adopted by Dr K.). The superficial stimulation consisted in the application of mammary excitation, embrocations, and especially of sinapisms frequently repeated. The deeper irritation being that derived from the daily use of the common breast-pump, by which we endeavour to increase the action or excite the latent function of the glandular tissue of the mamma. Dr K. had, he believed, witnessed the best effects from this combined mammary treatment in a number of cases which had recently presented themselves for treatment in his ward in the Infirmary. The following case was particularly referred to by Dr K., as affording a good illustration of what has been termed amennorrheal ulcer, i.e., an open sore either intimately connected with, or entirely dependant on, protracted absence of the menses:—
CASE OF AMENNORRHEAL ULCER.
Euphemia W., set. 20, was admitted into the Hoyal Infirmary on the 2d June. She had never menstruated. The left ankle joint was discoloured, swollen, and presented a considerable sized ulcer over the internal malleolus, which she stated had first broken out when she was 13 years of age, and had existed to a greater or less extent ever since. The history which she gave of her varied state of health, and the relative condition of the ulcer, was corroborated during her stay in the hospital, and this, along with the result of the case, proved the vicarious character of the ulcer. After remaining five months under treatment, during which time various efforts were made to heal the sore on the ankle, but which always had the effect of aggravating the amennorrheal symptoms, the mammary treatment was tried after the usual manner, when she became unwell for the first time in November; soon after which the sore on the foot began to heal, without being accompanied by the usual constitutional symptoms, and she soon afterwards left the hospital is apparently good health, and the ankle perfectly restored.
Morbid preparations were then exhibited, viz., 1st, A polypus of a singular character removed from the cervix uteri by excision, by Dr Simpson ; 2d, A specimen of a decidual membrane, by Dr Simpson; 3d, Uterus (and appendages) showing vesicular polypi of cervix, by Dr Keiller ; 4th, Organs of genemtio* of a female (found dead under suspicious circumstances) in which a complete circular hymen existed, by Dr Keiller. 5th, The uterus of a lioness that bad died three days after parturition, of peritonitis, showing the condition of the inner surface of the impregnated horn to be similar, so far as had been as yet observed by the naked eye and by the microscope, to the other horn which was unimpregnated, shown by Dr Keiller.
LIQUOR AMNII ABNORMAL QUANTITY. BT DR JAMES A. 8IDET.
Case 1.—Mrs B., Stevenlaw's Close, pregnant of her third child, when I saw her in December 1852, with Dr Aiken. She said she was six months gone; at that time she was as large as other women at full time. The oa uteri was open to about the size of a shilling; the foetal pulse could not be heard although examined several times. On the 1st January 1853, I was sent for and found her in labour; the abdomen was extremely large, but not pendulous, and the parieties so thin that distinct fluctuation could be felt. I left her, and was again sent for on the morning of the 2d, about five o'clock, when I found the os uteri nearly fully dilated, and the pains very rapid and strong, but not the slightest effect produced on the bag of waters, which was tightly stretched across the os. Believing that there was superabundance of liquor amnii, and over distension of uterus, I gave her a dose of ergot, had her brought to the edge of the bed, and ruptured the membranes with a quill, when about four gallons and a halfoi liquor amnii were caught in basons, and a great quantity besides flowed on the bed and over the floor. The child, evidently about the seventh month, was soon born, but dead; had been so for some days; placenta came away of itself. Uterus contracted well, and no hemorrhage followed. Woman made a good recovery.
Case 2.—Mrs M'K., Richmond Street, abdomen pendulous, pregnant of third child, at full time. Said she was much larger than on previous occasions, and thought she would have twins.
Nov. 19, 18*4, 10 a.m.—Labour was tedious during first stage from indurated os from ulcerations; but got great benefit from v. s. and Tart, ant and a bandage. The os uteri at length was fully dilated, but after that the pains made no progress; membranes were never pressed down. 1 had her brought to the edge of the bed, and caught in basons three gallons of liquor amnii, a good quantity flowing on the bed and floor, the child was born about two hours after; woman and child did well.
UNUSUAL FOETAL DEFORMITY—RETENTION OP PLACENTA. COMMUNICATED BY JAMES OERRARD, M.R.C.S., BUCRIE.
"The following case, which came lately under my care while practising in another part of the country, may not be without interest, as presenting a variety of foetal deformity, seldom, I believe, met with. In Sept. 1851, I was hurriedly sent for, to visit Mrs S., a sickly, unhealthy woman ffit. 37, in labour with her sixth child, the message being that the child was born, but that "all was not right," and, as the woman was iu great danger, urging me to hurry on as fast as possible. On reaching her house, some three miles from my own. I was glad to find matters not so bad as had been described ; the child, I was told, had been expelled some two hours previously, and had manifested no signs >f life, the placenta was not removed, the hemorrhage was little more than Moderate, there had been a large excess of liquor amnii, a binder had been tpplied, and altogether the patient felt comfortable. On applying my hand to ;he abdomen, the uterus was felt contracted but not firm, the os uteri I bund almost compressing the cord, wholly preventing me from detecting iny portion of the placenta. Considering the case one of irregular contraction, ind the symptoms not demanding immediate interference, I judged it the safest :ourse to administer an opiate, and await the result. Meantime the foetus was shown to me; it was full grown, the surface cold and collapsed, the cord properly separated and tied, the upper portion of the body was well developed, the lower extremities were joined into one by a continuation of the common integument, proceeding from the pubis downwards ; the soles of the feet were in close apposition, the phalanges of the toes alone being apart from each other, ind from those of the opposite foot ; there was thus properly no perineum, no anus, the only appearance of sexual organ being a small portion of reflected cuticle in the centre of the pubis, not unlike a rudimental penis. The bones of both sides of this double and single extremity could be easily defined through the structures, and seemed well developed; the double thigh could be flexed on the pelvis, but the leg was firmly fixed in the extended position. I very much regretted being unable to examine the parts within this enclosed perineum, an inspection having been resolutely objected to. 1 am quite aware that in such circumstances, parties think it no sin to be not over-zealous about the preservation of life, but I had no reason to suspect, much less to attribute neglect in this instance; 1 had ever; confidence in the party who was pressed into the service as midwife, and the appearance of the foetus induced me at once to suppose that life had only been uterine. So great had been the excess of liquor amnii as to suggest to the attendants, in the absence of an inspection, the existence of flooding, which goes to confirm the fact noticed by most authorities on midwifery, that where this secretion is in excess, death or disease of the foetus may be anticipated. A fixed state of the knee with permanently extended leg must be ill adapted for accommodating the extremity to the maternal passages during the exit of the shoulders and breech, but in this instance, there seemed to be no difficulty, nor did the patient at the time detect anything unusual in her case. In cases of retained placenta from irregular contraction, some authors wholly condemn, while others give a sort of qualified toleration to the use of opium. No general rule will hold good in every case; in my hands opium has repeatedly been of signal service in irregular contraction, both before aud after the expulsion of the foetus, but I should not use it in every case of the kind. I must confess my general confidence in its power to subdue irregular contraction; the dose administered to Mrs S., (tinct. opii. qtt. xxxv.), had the expected effect; in little more than half an-hour after, I could feel the placenta through the soft and yielding os uteri. I continued to introduce my hand in the cone form recommended in such cases, until I could grasp the placenta, which I then found to be still attached to the uterus by a small portion of its extent, but by compressing it, and slightly twisting it together, I soon succeeded in removing it. The woman made a good recovery, and at the usual time was up and attending to her household duties."
IMPROVED NIPPLE TRACTOR.
Dr Graham Weir exhibited an improved nipple tractor, and which, he stated, he had found extremely useful in forming the nipple in cases of retraction. It consisted of a small vulcanised Indian rubber bag fixed upon a small glass nipple shield, but modified so as to fit the nipple and allow of its being raised without including more of the breast.
A modification of the uterine bougie was exhibited by Dr James Sidey, consisting in the separation of bulb from stem, with the view of its more easy and less painful introduction.
MEDICO-CHIRURG1CAL SOCIETY OF EDINBURGH.
SESSION XXXIV. FIFTH MEETING.
Wednesday, February 7th, 1855.—William Sellkb, M.D., President,
Case Of Cancer In Various Organs. Bt W. T. Gairdner, M.D.—The patient, an old man, had died in the House of Refuge, with no marked affection of any important organ. He had a large tumour in the neck, evidently a cancerous enlargement of the glands in that region. The microscopic examination fully warranted that diagnosis. In the liver there were a few cancerous nodules; and, what was interesting, one of them had been entirely converted into calcareous matter. Near the apex of one of the lungs there was a deposit, which, however, under the microscope, yielded no characteristic corpuscles, but a number of nucleolar bodies, which might be either cancerous or tubercular. The question remained, and it was one which Dr Gairdner could not solve, whether the deposit in question was a tubercular one, passing into a state of obsolescence, or whether this waB an instance of the two morbid changes progressing simultaneously.
Case Of Irregularity Of Vessels At Root Of Neck. By James Bpejcce, Esq.— The preparation exhibited the right subclavian coining off from the left side and back part of the arch of the aorta: from this origin it passed towards the right side immediately in front of the bodies of the vcrtebrte and posterior to the oesophagus and trachea—the oesophagus being displaced towards the right side. Mr Spence made a few remarks as to the bearings of the case on surgical practice, and as to the altered position of the inferior laryngeal nerve generally noticed in such cases.
Case Of Extensive Removal Of Lower Jaw. By James Spence, Esq.— The preparation was obtained from a patient on whom Mr Spence had performed the operation of disarticulation of one side of the lower jaw from within half an inch of the symphysis about thirteen years ago. About five years prior to that time, the greater portion of the right side of the jaw had been removed by Professor Fergusson, now of King's College, London. A dense fibrous texture connected the small portion of the ascending ramus of the right side with the remaining portion near the symphysis, whilst on the left side a similar texture occupied the place of the disarticulated bone—on both sides affording firm attachment to the masseters and other muscles, so that the patient during life had considerable use of the mouth.
Case Of Goitre In An Infant. By J. Y. Simpson, M.D.—Dr Simpson regarded the pathological specimen (which was handed round) as one of great rarity, and at the same time as of interest, as it satisfactorily disposed of not a few of the current theories as to the production of the disease. Mr Syme, for example, was inclined to ascribe it to the fact that persons affected with the disease were compelled from their occupations to climb great heights, where the air was less dense, and who lived in valleys where there was an equal stagnation ; others ascribed it to the use of snow-water, or of water impregnated with iodine. Now the specimen in question proved that goitre was not due to any of these influences. It had been obtained from a child which lived but a few hours after birth. When born, it was nearly asphyxiated, and it had ouly been kept alive by the presence of a catheter in the throat obviating the pressure of the mass. The brain was of small size, and was covered by a quantity of watery fluid, on the removal of which the brain was found to occupy only the posterior segment of the cranial cavity. The mother was an Italian by birth, and had never suffered from the disease. She had had seven dead children and three living. The cause of this mortality was diseased placenta; and latterly she had taken large quantities of chloride of potass with good