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cover the sarface of six or eight inches. The chief | The patient had been delivered two years before with seat of the pain is a little above, and to the left of, the very great difficulty and hazard,-go much so, that Mr. umbilicus, and at this point a solid mass can be felt Turton recommended most strongly that if she again beneath the parietes, giving rise to dulness on per. became pregnant, she should inform him early enough cassion. The pain is nearly constant, but greatly to produce premature labour at or about the seventh aggravated by purgative medicines. The fæcos are month, hoping by that means to save the child. At generally scy baloas, and occasionally mixed with that period be dilated the cervix and os ateri, and with blood; when scybalons, the membrane is usually not a blunt instrument punctured the membranes; and to be observed until the fæcal masses have been broken when assnred that the progress of utero-gestation was up. The bowels seldom act without artificial means, arrested, and some degree of expulsory effort was enemata causing rather less pain than purgatives taken established, he administered the secale in the form of by the mouth. Diarrhea is occasionally present; the diluted essence, increasing the dose as the effect passing of the fæces is, however, not less painful than increased, so as ultimately to prodnce sufficient es. when the bowels are constipated. The membrane ispulsory effort. The whole process occupied about a now lighter coloured than when first obserred; the week. In this case he was guided by the conviction, pieces were formerly quite black, and “just the colour / that if the ergot was able to generate true aterine of a damson's skin;” now they very much resemble contraction, of which he entertains some doubt, it would busks of oats.
pot be the safest coarse to excite expulsory efforts to INDUCTION OF PREMATURE LABOUR.
its more direct effect, before the cervix and os uteri were Mr. Turton read a paper on the induction of pre.
80 developed as to admit of safe and easy expulsion. mature labour. He stated that the induction of pre
This was at length effected; the child lired about two mature labour bad for a long time been practised in
days. The death he was inclined to think might not this country, and might be regarded as justifiable in
have occurred if the membranes had not been ruptured, two classes of cases. First, in that class in wbich
but merely separated in the first part of the process to delivery has been repeatedly effected by the use of the
arrest atero.gestation. lever or forceps, the children being still-born; or, The subject of the second case, Mrs. I , aged 29, secondly, where the perforator has become necessary had borne five children in four labours; the children from some insurmountable obstacle to the delirery of were all full grown, bat, excepting the last one, did not the child, especially from that deformity of the pelvis live long after birth. The surviving one was a very which proceeds to actual distortion. In the first the small one. The labour was very difficuit and tedious, sole intention may be to indace labour at the most from the existence of deformity. The medical man fitting time which is compatible with the viability of who attended her declined to attend her if ever she tbe child,-namely, the seventh or eighth month, was in labour again, and about the fifth month of (although living children born at an earlier period are pregnancy she applied to Mr. Turton. There was at recorded,) which is generally the most likely time. that period very great difficulty in making an exami. It unfortunately bappens occasionally that the difficulty nation, from the close approximation of the rami of is insurmountable at eren an earlier period, in which the pubis to those of the ischium, and also from the case a surgeon is not justified in delaying even to the approximation of the pubes to the promontory of the sixth month, as by such delay the danger may be much sacrum, the space being at the superior entrance not aggravated. Different plans have been proposed, more than one inch and a half. The aperture was for instance, the rupture of the membranes, or the very small on the left side, rather larger on the right, separation of a portion of the membranes from the but by no means affording space for the exit of a child, cervix uteri. Where the deformity is not very great, even at the seventh month. There was also great this plan has decided advantages; but where the dis. spinal deformity. The difficulty had increased with tortion is extreme, it will not at all times be possible. every labour. The dangers and difficulties of the case In the first case a blant instrument, as a metallic were fully stated to the patient and her friends, and she bougie, may be used, either to rapture the membranes, was informed of the absolute necessity for producing or to separate. It is not essential to have an immediate premature labour at the earliest period possible. On discharge of the liquor amnii, neither is it to be positirely the 12th of September, being in the fifth month, Mr. considered that rupture has not been effected because Turton endeavoured to reach the os uteri with the the discharge does not immediately ensae. . It is fore finger of the right hand, supposing from the a matter of some importance to keep the patient pendulous abdomen, that it would be found towards at rest until there are indications of uterine contraction, the promontory of the sacrum; this was not the case, in order that the system may be prepared for the pro and by using the left finger be found it over the cess of partarition, Mr. Turton's opinion is that it symphisis pubis. He tried to dilate the os uteri, in is always best to allow the process of uterine contraction order to separate the membranes from the cervix, but to commence leisurely, witbout resorting to the secale, could not effect it, as the arch of the pubis was too which, possessing an expulsory power, and not a much contracted to allow of the introduction into the dilating one, should only be used as a powerful auxiliary vagina of any part of the band. He then introduced when the cervix uteri is developed.
a metallic sound, in order to rupture the membranes, The first case was one in which premature labour as far as he could venture to do. No water escaped ; was induced, in order to save the life of the child." it did so in the former case. On the 13th she had
passed a good night; a dose of castor oil had evacuted exactly like the skin of washerwomen who use strong the bowels ; micturition free; no pain in the aterus, solutions of potasb ; at the same time these parts but some in the back; in good spirits. She went on inflame, and become more or less red, or yellowish, and in this way until the 16th, when she complained of fissures are observed at the natural bends of the member. pain in the back and loins, as if uterine contraction Having arrived at this point, the disease may remain were commencing, and there was a slight watery dis. 1 stationary for a short period, when the epidermis charge. In order to aid this effort, the ergot was begins to scale off without being reproduced, and the ordered to be taken thrice a day. 18th. Utero-gesta. diseased surfaces assume a novel and peculiar aspect, tion decidedly arrested; uterine efforts well marked; The swelling bas now disappeared, and the hardened discharge much more abundant, and rather fætid. To epidermis is replaced by a new skin, of so slender a continue the ergot every six hours. 19th. No oppor. testare that the colour of the derma beneath is tunity of examining, but the labour evidently pro- distinctly visible. Whether they had previously been gressing. Ergot to be taken every four hours. 20tb. red or pale, the feet and hands now invariably become 6 p.m. Pains increased, and much more propulsive; of a livid or coppery bue, especially at the pulpy part bowels open ; micturition free; no unfavourable of the fingers and toes, and around the nails; the nail symptom. About 9 p.m. Mr. Turton was summoned itself is softened, and surrounded with small ulcers. in haste, found the patient in bed, and was told someo! What remains to be said of other forms of syphilides thing had passed. On examining he found the fætus in infants, will not long detain the reader. New-born enveloped in the membranes in the bed: they contained infants are subject to all the forms of secondary disease also a portion of the liquor amnii, and were not fully / which attack the adult; the eruptions are similar, and ruptured. The placenta soon followed. No hæmo. it is therefore unnecessary to enter into details which rrhage, neither-after pain, of any moment. The uterus may be found in other writings. We shall merely readily contracted. The fætus was a healthy, well. point out the differences between syphilis as it appears formed one, about the fifth month. As there was strong at the two ages. reason to believe that the membranes were not punc. Syphilitic roseola is the most frequent of the syphi. tared at any depending part, but that the decidua was litic eruptions of the new-born infant. It.commences partially detached from the cervix uteri, thereby by disseminated points, but soon becomes confluent; arresting utero-gestation, the unbroken bag of waters though an early symptom, it seldom precedes the would facilitate the dilatation of the os uteri, and Mr. I cortza. It appears with great rapidity; we have seen Turton considered this was a reason to endeavour in it cover the entire body in the space of a night; it also, such cases to merely separate the membranes, and not under proper treatment, disappears with almost equal to rapture. The patient has progressed favourably; promptitude. In some instances it disappears, and she has not since menstruated, and does not recover again re-appears, with rapidity; we have noticed two very rapidly her powers of locomotion.
or three such occurrences in the same subject. Syphilitic Mr. Tarton deduced from these cases1. The safety
duced from these cases-1. The safety roseola is not a severe symptum in itself, but it must and value of the induction of premature labour. 2. be remembered that it is often the precursor of. more That the means used are both safe, and, in general, | serious lesions. The papulæ may, for instance, be easy. 3. Tbat the ergot is a valuable auxiliary, and transformed into pustules, and these again into ulcers. that the best time for its administration is when we are Pustular syphilide, psoriasis, and mucous tubercles, satisfied that utero-gestation is arrested, as indicated by are of less frequent occurrence than the above. the pains and the muco-sanguineous discharge. ineptioned exanthem. When the secondary eruptions
of new-born children commence in the pustular form,
they are soon covered with thick brown crusts, the Foreign Department.
colour of wbich is apparently attributable to the admis
ture of blood. The pustules are of variable form, and ABSTRACT OF A MEMOIR ON INFANTILE sometimes affect a circular arrangement, but not with SYPHILIS.
sufficient constancy to afford a means of diagnosing By M. TROUSSEAU.
the specific malady.
In order to entertain & . just appreciation, of the (Translated for the Provincial Medical and Surgical Journal.)
symptomatic value of these lesions, it is necessary to (Continued from page 665.) i
take their situation into account. : . It is in fact in Too much importance can scarcely be attached to this circumstance, and the regular stages which they the seat of syphilitic eruptions, for often a symptom in go through, thát syphilitic eruptions differ from others. itself of no value becomes highly significative from the If difficultiesi sometimes arise in determining the fact of locality only; thus patches of scaly eruption specific origin of resicular and pustular eruptions of on the face or trunk would not justify a conclusion that the skin, it is not so with the “flat tubercle." This is the disease is syphilitic, but the same occurring on the an especial sign of secondary syphilis, and puts on palms of the hands, does not admit of doubt. Two precisely the same appearance in the child as in the periods may be distinguished in the alterations which adult. Their ordinary seat is around the margin of occur on the extremities; at first the skin which the anus ; but they may also appear on any portion covers the palms of the hands and soles of the feet is of the body, especially in parts where a duplication of wrinkled, it becomes notably thickened, and 100ks the skin favours the accumulation of irritating secretions.
The labia majora in the female, and the scrotum in the
General Retrospect. male infant, are often affected by them; more rarely they appear on the inside of the cheek. The mucous tubercle ulcerates with facility; when it
PRACTICAL MEDICINE. is about to yield to treatment, the base becomes less hard, and the ulcer is covered with prominent granala.
MERCURY IN THE LAST STAGE OF ACUTE
HYDROCEPHALUS. tions. The tubercle either develops itself upon sound skin, or it succeeds to a patch of erythema or psoriasis;
The opinions of the author, M. Golfin, are based its size is variable, but seldom exceeds that of a upon an extended experience, but of his many cases sixpence.
in which the above medication was found of advantage, The last secondary symptom which we have to he only relates three. notice, is that of ulceration of the skin. These ulcers, In the first example the disease had reached the whether they follow the preceding eruptions or are stage of effusion in spite of a well-regulated and caused by accidental injury of the skin, exhibit two judicious treatment. The pulse was slow and feeble ; different aspects, accordingly as they are superficial there was profound torpor; swallowing had erosions, or deep-seated genuine ulcerations. Their impossible; the eyelids were half opened, and the seat is variable, as in the adult, but they are most pupils dilated ; the respiration was slow and irregular, frequently seen in the neighbourhood of the genitals Under these hopeless circumstances, M. Golfin rubbed and buttocks, and it is there that the skin is fre. in & drachm of mercurial ointment every four hours. quently irritated by the urine, &c. This irritation, On the next day some improvement had taken place, which in a healthy infant wonld readily subside, in and on the fifth day the child was out of danger. the syphilitic child proceeds to very intractable ulcera. In the second case the disease bad reached the eighth tion. The form and aspect of these ulcers are the day. The symptoms were,-dilatation of the pupils, same as in the adult. Such are the symptoms by coma, with convulsions of the features. Bleeding and which the syphilitic virus displays itself in the new blistering, &c., had been adopted in the first instance, born infant. Some of these are invariably seen; others with some benefit; but effusion had nevertheless taken may be occasionally absent; others again are observed place, and was on the increase, when mercurial inanction in the majority of cases, though not constantly. The was resorted to as in the former instance. At the end disease nerer, however, confines its manifestation to of six and thirty hours, considerable benefit was one individual symptom, but has three or more forms, observed, and the case became rapidly conralescent. which succeed each other with a certain regularity. The | The third case was in every respect similar. most common order is that in which we have described [As we have no information of the early symptoms them.
in the above cases, it is not easy to determine to what At the same time that the local symptoms gain ground, form of cerebral affection the effusion was to be the cachexia becomes more and more marked. The attributed. Had they been instances of tubercular infant wbich came into the world to all appearance meningitis, the ordinary form of disease to which the healthy, becomes pale and sallow; the eye-lids are term acute hydrocephalus is applied, it is to be doubted tumid, and the eye-lashes drop out. If any wound is whether the benefit described would have ensued.)inflicted by accident, it is slow to heal, and puts on a Gazette Medicale, September 11, 1847. bad aspect. This cachectic condition we regard as the veritable expression of the sypbilitic infection, and
TREATMENT OF EPILEPSY. in no wise depending upon anti-hygienic conditions,
Dr. Marshall Hall says that the idea of a remedỹ for or mal-assiinilation of food alone. The degree of
this disease, is for the most part a superstition not more wasting does not appear to be in proportion to the
deplorable than the dependence upon an amulet. The local affection, as we have seen the most extensive
first thing to be done is to ascertain the causes of the and foul-looking ulceration coincident with a trifling
disease, and to avoid them; if the cause of the epileptic amount of failure of the general powers, and vice versa.
convulsions be gastric or enteritic irritation, the stomach The syphilitic infant generally dies by gradual
and bowels are to be promptly reliered. In that form wasting, terminated by an exhausting diarrhea; but of epilepsy which arises from uterine irritation, every in some cases the death is more sudden, the child precaution should be adopted which can allay it, such sinking in a day or two without affording any signs by
as warm fomentations to the uterine region, warm which such a termination can be foreseen. After death vaginal injections, &c. The next point which demands it is not always possible to account for the event, but attention is the state of sphagiasmus. The head in most cases it is to be explained by the effusions
should be raised, the neck exposed, and forced inspira. which are discorered in the pericardium or pleara.
tions excited by dashing cold water on the face. The rest of the treatment at this period of the seizure cona sists in free exposure to the open air, applying cold to the head, and if there be convulsions, guarding the patient from injury.
Much depends upon the regulation of the sleep in epileptics. Every precaution should be taken to prevent the sleep from being too deep, or saddenly disturbed. The patient should retire early, and have
some one quietly, but constantly, moving about the repeated doses of morphia proring utterly powerless room. Such early sleep, quietly interrupted, is not so to produce sleep, the patient was found on Friday deep as that which takes place in the stiller and darker morning still in a state of wakefulness and high delirian, periods of the night. The object is to ward off an but so much exhausted as to make it a matter of the attack and to break the habit of periodicity.
higbest moment to induce sleep immediately. In this All mental excitement must be aroided, with heated condition it was thought expedient, as a last resort, rooms, and late hours. The diet must be simple and to make trial of æthereal inhalation, and the æther was putritious, without stimulus; the bowels must be accordingly administered by the sponge. carefully watched and regulated, and the skin must be The patient was very refractory, and required to be excited by tepid or cold spongiog, followed by friction held by assistants, in the meanwhile struggling, raving, with a course towel.
and cursing. After inhaling the vapour for the space "All these things must be done carefully and per. of ten or twelve minutes, he appeared quiet, and was severingly by those who would do everything to remove thought to be fully under the æthereal influence; but the great eril. There is no royal road to bealth in upon the removal of the sponge he sprang op and such a case, and they who trust to a mere remedy, commenced raving anew. The process was repeated, whether it be fætid as assalætida, blue as indigo, and continued for ten minutes wore, at the end of or be brought from the Hague, or as far as the Indies, which time the patient was brought fairly under the to the exclusion of those means which can reasonably desired influence, and fell asleep. From this state of conduce to recorery, are guilty of the danger to mind arlificial sleep he passed, without waking, into a quiet, or life of the unfortunate patient."-Lancet, October | deep, and un troubled slumber, which continued, without 30, 1847.
intermission, for four hours and a half. He was seen
several times during the continuance of this sleep, and ÆTHEREAL INB ALATION IN DELIRIUM TREMENS.
within a few minutes after he awoke. He then appeared By Dr. Upham, Boston.
perfectly rational, called for cold water, and asked to
have his leg dressed, (he had bruised it badly during William Perry, an Irishman, 48 years of age, is
the delirium.) In the course of half an hour he fell of sanguine temperament, strong and robust frame, and
again (as was anticipated,) into a quiet sleep, which has generally enjoyed Arm health. He is a hosiler
continued, with few intermissions, during the afternoon by occupation, and has been a man of intemperate
and night. This morning (Saturday,) he appears habits for many years. On Monday, July 12th, he was committed to the House of Correction, baring for sereral
perfectly rational and well, though, weak. Has no,
recollection of anything that has happened, from nightdays previcusly been drinking very freely, according
fall on Monday to the time of his first waking on to his own statement. On the same day he presented
Friday afternoon.-Boston Medical and Surgical Journal, himself to the hospital as an out-patient, for treatment
August 17th. of chronic ulcer on the leg. At that time he shored
SURGERY. no indications of delirium tremens, with the exception
OPERATION FOR ENTROPIUM. of slight tremors, manifested particularly about the
Instead of cutting through the entire eyelid, as in hands. Towards evening be grew wild and uneasy, Crampton's operation, Dr. Wallace has for some vears tremors increased and became general. Slept but past made an incision through the entire length of the little during the night, and was found next morning
tarsus, about the eighth of an inch from, and parallel in a state of high excitement, with tongue thickly
to, its margin. From this incision to the margin he coated, pupils dilated, lids tremulous, muscles oni.
cuts through the tarsus again, at each canthus, and at versally agitated, pacing, his cell, talking incessantly,
the middle, making the letter m; or; if the curvature and raring incoherently.
is very great, be makes more perpendicular incisions. During the following twenty-four hours the patient
the patient | Threads are then drawn through the integuments, and showed all the usual symptoms of delirium tremens in a
fastened to the forehead, as in Crampton's operation. marked degree. He slept none, but walked the floor
| As the curved tarsus only is divided, the deformity without intermission, talked disconnectedly, and, as
ud, as occasioned by cutting through the integuments in is usual in like cases, busied himself in the performance | Vare's and Crampton's operations is avoided. of imaginary tasks. He was constantly pressing against
From the lifeless relaxed state of the eyelids, after, the walls of his cell, or endeavouring, with the fancied
the application of the vapour of prussic acid for opaci. assistance of horses, to remove the iron door. Mean
ties of the cornea, he would be inclined to try its effects while, if questioned, he would answer to the best of
in diminishing the irritability of the eyelids previous his ability, and obey directions with alacrity for the
to an operation.-- Boston Medical and Surgical Journal. moment, but immediately relapsed into his previous state of delirium. This, at times, assumed a violent
MIDWIFERY. form, so that it was deemed necessary to take away | RULES OF TREATMENT IN PLACENTA PREVIA. his bed and all other moveable articles within his reach, . Dr. Alexander Tyler's paper in the Dublin Quarterly, and keep attendants by him day and night to protect Journal, (May,) terminates with the folloving rules of him from injury. For the succeeding forty-eight hours, practice :this state of things continued with but little variation, 1. In cases of partial placenta previa the memall the grave symptoms ipcreasing in severity.
branes should be ruptured as early as possible, and the The usual treatment baving failed, and large and I uterus emptied of its fuid contents.
2. In the same class of cases after the escape of the stains. The above affords the medical jurist an aseful liquor amnii, sbould vigorous uterine action pot ensue, hint in certain cases of poisoning in which it is not to encourage this end by means of friction over the possible during life to obtain the excretions for the fundus uteri, the application of a binder, the administra purpose of analysis.--Gazette Médicale, Octobre. tion of ergot, or the use of galvanism, as recommended by Dr. Radford,
3. In complete placental presentation when the os PREPARATION OF CHLOROFORM. is rigid and undilated, never to attempt to extract the We have been favoured by Professor Simpson with the placenta through it in that state, but to plug the vagina subjoined remarks on the preparation of Chloroform carefully with sponge dipped in vinegar and water. “I have seen different instances reported in the English
[We need not point out that this is too sweeping a and French Journals of patients requiring to inhale Tecommendation.]
chloroform for five, len, and even twenty minutes, before 4. As soon as the os uteri is sufficiently dilated, to
they came under its influence. In all such cases, the seize a foot and deliver cautiously.
chloroform used must have been of a most inferior quality. 5. If the child be dead, and the head presents, it I have generally seen patients affected in about a minute; may be perforated.
they rarely resist it for above two minutes ; and never, 6. As I attribute the cessation of hæmorrhage in or almost never, above three. The chloroform which I Dr. Simpson's cases of extraction of the placenta, to have mostly used, is that manufactured by Messrs. the fact of the uterus being thereby emptied of its Duncan, Flockhart, and Co., chemists, Edinburgh. It Auid contents, and allowing the presenting part to be is made according to the following formula of Dumas :pressed against the bleeding orifices, that in certain
"R. Chloride of lime in powder, .. 16. IV. cases the placenta might be pierced with a gum elastic
Water, . . . . . . . . lb, XII catheter, and the liquor amnii thus allowed to escape.
Rectified Spirit, . . . . . . (-02.XII ETHERIZATION IN MIDWIFERY.
“ Mix in a capacious retort or still, and distil as long as M. Roux'terminates a memoir on this subject by the a dense liquid, which sinks in the water with which it following conclusions :
comes over, is produced, 1. Women in labour are as readily brought under
“The product obtained by the above process, is rectified the æthereal influence as others.
by agitating it with several portions of strong sulphuric 2. The puerperal condition does not modify the acid, and afterwards distilling it from carbonate of baryta. effects of æther, nor is it injuriously influenced by it. Messrs. Duncan and Co. inform me, that they always distil
3. In ordinary labours, the annihilation of pain has it a third time from lime, and that they believe it would be no injurious effect,
| impossible for them to furnish it perfectly pure without 4. In laborious laboars, it is right, for the sake of this. Latterly, they have made and sent out fron 60 to both mother and child, to annihilate pain.
80 oz. per diem (2s. per oz.,) manufactured by this 5. The uterus and abdominal muscles continue to process. In the observations which I previously published, act energeticalls dnring @thereal trance while the I inadvertently omitted to state and insist upon the perineal muscles relax. A cessation of uterine con.
purifying part of the process. traction, when æther is employed, is not observed
"Of several specimens I bought in Glasgow, only oftener than onder ordinary circumstances.
one was of the proper strength and purity. I bought a 6. The child is unaffected by the æther.
specimen yesterday in an Edinburgh shop, sp. gr., only 7. The consequences of labour are not injuriously
1.130 instead of 1.480. There was little or no chloroform modified by the effects of æther.
in it.” 8. Recovery seems, as in the case of surgical opera
1 Dr. Simpson believes that all the reputed failures and tions, to be expedited by it. Gazette Médicale, Oct. Ime misadventures are attributable to two causes, viz.,
11. using an impure and imperfect variety of chloroform ; TOXICOLOGY.
and 2. not giving it in sufficiently large and rapid doses. DETECTION OF ARSENIC IN THE FLUID OF A BLISTER.
M. Legroux, of the Hospital Beaujon, was sum. moned to a young woman who had the evening before
SCARLATINA ANGINOSA. swallowed arsenic for the purpose of committiog suicide, In cases of scarlatina anginosa, where we are dis. but refused at the time to give any explanation of appointed in the expected convalescence, is it not from her symptoms. The dejections from the stomach and the morbific matter or serum thrown off from the bowels bad been removed, and the urine was scanty, fauces and diseased glands, which is absorbed by the Not having a clear insight into the case, M. Legroux small veins; these communicating with the internal applied a blister, and submitted the serum of the vesi. jugular vein, by which it is readily carried to the heart cation to M. Chatin for analysis, together with some | itself, and so acts as a poison ?' The same in angina of the urine.
maligna. In the early stage of this inftammation, I hare After destroying the organic matters of the serosity found unquestionable advantage to arise from the use and the urine, M. Chatin dissolved the residue in dis. of a pretty strong solution of lunar caustic; and some tilled water, and tested for arsenic with Marsh's appa. of the practitioners of the neighbourhood in which I ratus. Both Auids gare numerous distinct arsenical / reside can confirm what I have said. The mode here