高丝莱菲os was gradually dilated by sponge-tents. After two or three days, it was large enough to admit the finger. The surface of the uterine mucous membrane was now found to be studded with small bodies, about the size of beans and peas, in larger number about the internal os, but generally scattered over its whole surface. Tho about the internal os were larger, and when the speculum was forcibly presd against the os uteri, this was in part opened, and small polypous mass could be en protruding. The were removed by a pair of pinchers, being first twisted, and forcibly extracted. The resistance of some of the, and the size of the pedicles, prevented the scraping out of tho in the cavity by a curette. The patient was therefore left for a few days, till an instrument could be devid for their removal.
At the suggestion of his colleague, Dr. Savage, Dr. Routh had an instrument prepared by Mr. Coxeter, the best idea of which is, that it was like an ordinary silver spoon, with the projecting convex portion removed, slanting inwards towards the handle, the upper and therefore most projecting convex end being made so as to cut.
The os having been now dilated for two or three days suc-cessively, as before, by sponge-tents, the instrument was in-troduced, and the polypi gradually removed by thin slices, till the mucous membrane of the uterus felt quite smooth to the finger. There was very little haemorrhage, but for some hours a. g
ood deal of colicky pain, which, however, gradually pasd away. A solution of iodine, first of one part to three of water, then to two of water, then in equal parts, was now thrown up once or twice daily for two or three days. The strong solution produced a little pain for some hours. Finally, by means of Simpson’s instrument, a little powdered caustic was introduced on the fourth day after the operation. This caud no uneasi-ness, and the patient was left to herlf. Ordered a gentle tonic, and the douche daily. The discharge gradually diminished, till, when she left, it was nearly entirely watery. It was thought wir not to check this last too soon, a drachm of bitartrate of potash being given every morning to relieve the habitually congested habit of the parts.
This ca is full of interest. The question might be asked-Was the catamenia which she had during former pregnancies in any way connected with the small polypoid growths ? Again, this is a ca which proves the immen advantage to be derived from digital examination of the lining membrane of the uterus; nor do we think, looking to the size of some of the polypi, anything short of the scraping of the uterine mucous membrane with an instrument like the one devid could have effectually cured the patient.
ST. PANCRAS ROYAL DISPENSARY.
FALL ACROSS A CHAIR BY AN EIGHT-MONTHS PREGNANT WOMAN, WITH LACERATION OF THE GENITALS AND ESCAPE OF THE LIQUOR AMNII; REGENERATION OF THIS FLUID, AND DELIVERY BEYOND THE FULL TIME.
(Under the care of Dr. GIBB.)
DURING the pregnant state how often do we e rious injuries sustained, which do not prevent the female from going On to her full period and ultimately lying in, without bad results either to herlf or her offspring ! If the nature of the injury be such as to produce a sudden rupture of the mem-branes and escape of the amnial fluid, as occurred in the fol-lowing ca, some anxiety is felt lest the result should be pre-mature labour. Most generally it does ensue, and yet the instance which we briefly narrate cannot by any means be a solitary example in which the whole or greater part of this fluid has escaped without the induction of labour. The pro-ininence of the abdomen greatly diminished; it was quite soft and flaccid, and in the cour of a few days it began to get prominent again, until, by the cretion of fresh fluid from the amnion, it had assumed its natural size and form; and when, we may say, the tenth month was completed, labour t in with no unusual result.
Mrs. T--, aged thirty-three, a small spare woman, the mother of four children, and just eight months g
one with her fifth child, was standing upon a chair, in the afternoon of the 7th of January, and was lifting her right foot on to the sill of the window to hang up something, when the chair slipt, and she fell straddleways across the back of the chair, and then.
with the chair, fell heavily on to the ground upon her side. Simultaneously with the accident there gushed about a pailful (as she describes it) of blood, but which proved to be the liquor amnii and blood, which continued to flow for a little while and then diminished, a little discharge of blood, however, still continuing. She was verely hurt in the external parts, which were found to be lacerated on Dr. Gibb’s eing her, about two hours afterwards. The part injured was the upper portion of the left nympha, which was torn across, and was very sore and tender. A pencil-shaped clot of blood protruded from the urethra, but about an hour before she pasd her urine naturally and without difficulty. The vagina was un. injured, and so was the uterus, so far as could be ascertained. The abdomen was quite soft and flaccid over the uterus; its prominence had greatly diminished from the loss of fluid, but the motions of the child were distinctly felt. She had suffered some slight collap, and was very cold; reaction, however, t in, and the pul became moderately full, soft, and 88 in number. She expresd some uneasiness about her children. The bleeding had quite cead, and she now lay quiet and tranquil. An anodyne draught was ordered of laudanum and camphor mixture.漆皮鞋怎么护理
Jan. 8th.-She has pasd a good night, with occasional bleeding from the wound. To-day she is free from pain; her abdomen is quite soft; no labour pains.
She went on well without a bad symptom, and attended to her houhold affairs. The abdomen slowly filled after a few days. Her bowels were relieved once only by a do of castor oil, and the wound perfectly healed up.
Feb. 5th.-She has gone on quite well without any bad symptom; the uterus has become filled again by regeneration of the liquor amnii, and the motions of the child are quite strong. The abdomen is now much larger than before the accident, and her health is good.
March 28th.-Labour t in at nine o’clock this morning, and birth was given to a female child at the same hour on the next day. The membranes ruptured six hours after the commence-ment of labour, when a very large quantity of liquor amnii escaped, followed afterwards by a good deal of Imraorrhage. The head was high up, and the prentation that of the hand across the head. The labour was somewhat tedious, but deli-very was satisfactorily accomplished, with the hand at the side of the head.
She had no untoward symptoms after delivery, and got up on the tenth day. The patient states that s
he has had a better time of it than with any of her previous children, and that the labour was quicker. Both mother and child are now (May 15th) quite well.
We may remark that, according to the period of delivery, as stated above, which took place two months and a half after the accident, some doubts might be felt as to whether she was actually eight months gone at the time of its occurrence. This, however, she states to be the ca, and, on careful inquiry, there ems no reason to doubt the truth of it.
It is quite possible that the period of utero-gestation was pro-longed, from the very fact of the loss of the liquor amnii, the complete repo thus given enabling the uterine contents to assume their normal condition.
CLINICAL RECORDS.
REPAIRS OF STUMPS AND FRACTURES.
AT Guy’s Hospital on the 4th May stout healthy man was brought into the theatre, having fractured the lower part of his fibula, with a dislocation of his tibia inwards, about a year ago. Probably at the time of the accident the sole of the foot turned outwards, with its inner edge downwards. This frac-tur
e and dislocation were attended to in the usual way, but was followed by an unusual projection of the tibia inwards, which was not only unsightly, but very awkward for the patient. Mr. Cock on this occasion cut down upon the projec-tion, and removed all that was necessary by means of a mallet and chil, under chloroform, and we learn that since this pro-ceeding he has gone on well.
Three years ago a healthy-looking girl had her thigh -ampu-tated in University College Hospital for osous anchylosis of the knee-joint, existing since she was a year old. The stump was good at the time, and the wound healed kindly. But since that time, although the end of the bone is well covered by in-tegument, it is somewhat in! the way of an artificial leg, and from disu the stump generally has become wasted and atro-
叽叽叽叽504
phied. This was remedied on the 12th May by making an in-cision in the line of the old cicatrix, when Mr. Erichn re-moved with a Butcher’s saw nearly an inch of what may be called a pencil of bone, which no doubt had not had sufficient capacity to act as a resisting body. This has perfectly healed. We now and then e the end of the bone removed in cas of conical stump, but this was not one of that kind.
请婚假
SUBCUTANEOUS NEVUS OVER THE ANTERIOR
FONTANELLE.
WE saw Mr. Erichn treat a congenital nvus over the anterior fontanelle of an infant twin, a few weeks old, at University College Hospital on the 28th April, in the following manner :-A puncture was made through the scalp on one side of the nvus, and a blunt needle-eyed probe armed with a liga-ture was pasd through the ba of the nvus to the opposite side, which emerged through another opening made with a knife. This was repeated at right angles to the first thread, and the four double cords were firmly tied, through fissures made in the skin, around the tumour, and complete strangula-tion effected. No cerebral symptom was manifested during the process. In such cas as the Mr. Erichn does not u Needles in the usual way, becau the membranes of the brain might be punctured, and death might ensue. But when per-formed in the manner described, there is not the same risk, and in about half a dozen cas thus treated by him no accident or untoward symptom occurred, and the nvus was got rid of. When a nvus is situated over a bone, of cour the sharp needles may be employed, as is commonly witnesd.
尿酸高能吃豆芽吗All the numerous and varied methods employed for the re-moval of naevi are considered at length in
most surgical works, but scarcely one refers to a naevus over the anterior fontanelle, which common prudence would teach us requires to be managed differently from nvi in ordinary and less important situations.
DISLOCATED ELBOW AND THUMB FROM A FALL.
网络歌曲下载
A TOUTM man, aged twenty-three, while driving a cart, was thrown out of it, and fell on his hands and feet. The result was a dislocation backwards of both bones of the left elbow, and a compound dislocation of the head of the first phalanx of the thumb of his right hand, which protruded through the skin. He was taken to Guy’s Hospital, and admitted under Mr. Birkett’s care, who reduced the dislocation of the elbow &st, and then sawed off the head of the protruding bone of the thumb and clod the wound. This united rapidly by ad-hesion; and three weeks after the accident he was perfectly well in every way, with a uful hand and arm.
The practice adopted in this instance, in treating the com-pound dislocation of the first phalanx of the thumb on the metacarpal bone, is that generally recommended,-namely, to saw off the head of the phalanx before reduction; and it is a proceeding which answers admirably. So far as we could judge, the man would have a good movable thumb, with all its powers of flexion and extension.
CARBUNCLE FOLLOWING A BLISTER, AND
BECOMING PHAGEDaeNIC.
THERE is an elderly female at the prent time in St. George’s Hospital, under the care of Mr. H. C. Johnson, with dia of the right hip-joint. She was blistered over the hip in the latter part of March last; this was followed, a week afterwards, by some irritation of the cutaneous surface, and a carbuncle ap-Ileared in the site of the blister. This was opened a few weeks back, and exit given to matter and cellular tissue. The car-buncle was healing, when it was attacked with phagedasna of rather an obstinate character. The application of the tincture of benzoin failed, but the strong nitric acid had the effect of checking it, and the ulceration has nearly healed. Her general health appears to be pretty good.
Now what was the cau of the carbuncle in the first in-stance ? Was it the blister ? we should say not; but as there *Was most probably a vitiated state of the blood and the cre-tions, the blister was an accidental means for its explosion through the formation of a carbuncle. This patient’s system, too, was below par, which accounts for the prence of the phagedwna.
Reviews and Notices of Books.
A Manual of Psychological Medicine; containing the History,
Nosology, Description, Statistics, Diagnosis, Pathology, and Treatment of Insanity. With an Appendix of Cas. By JOHN CHARLES BUCKNILL, M.D. Lond., Medical Superin-tendent of the Devon County Lunatic Asylum, &c.; and by DANIEL TUKE, M.D., Visiting Medical Officer to the York Retreat, &c. London: John Churchill. pp. 562. 1858.鸡蛋糕的做法
白羊座和水瓶座
UPON most branches of medical science we have been well supplied with text-books; but as regards that branch which deals with insanity we have been somewhat deficient. Dr. Prichard’s treati has been generally referred to. It is now out of print, and, moreover, was written twenty-five years ago. We have had excellent essays upon particular departmentsof p sycho-logical medicine; but no conci, systematic treati upon t that could be ud by the student and busy practitioner. Drs. Bucknill and Tuke have well supplied our deficiency, and their " Manual" must be regarded as one of the noteworthy publi-cations of the day. As the authors remark, a knowledge of the nature and treatment of insanity is now expected of every well-educated medical man, the India Board requires it of all persons to whom medical appointments are given under their new system of competitive examination, and no doubt the desire to obtain a competent knowledge of so important a branch of medical practice will become far more general in the profession than it ever before has been. But
" The authors are aware that no amount of reading can render it safe to dispen with clinical knowledge of mental dia. Their aim has been to supply a text-book which may rve as a guide in the acquisition of such knowledge suffi. ciently elementary to be adapted to the wants of the student, and sufficiently modern in its views and explicit in its teach. ing to suffice the demands of the practitioner. "-p. iv.
The work is divided into ten chapters, and an appendix. Chapter 1 contains an " Historical Sketch of Insanity amongst the Nations of Antiquity, mainly in regard to its extent." Chapter 2 is on the " Opinions of Ancient Medical Writers on
the Treatment of the Insane." Chapter 3 deals with " Mo. dern Civilization in its bearing upon Insanity," whilst chapter 4 treats of the " Amelioration of the Condition of the Insane in Modern Times, especially in regard to Mechanical Restraint." Chapter 5 is allotted to the " Definition of Insanity and of Classification;" chapter 6 to the " Various Forms of Mental Dia;" and chapter 7 is occupied by the " Statistics of In-sanity." It has been Dr. Tuke’s duty to treat of the above subjects. Dr. Bucknill makes his appearance in chapter 8, which is upon the " Diagnosis of Insanity." Chapter 9 follows with the " Pathology of the Dia," whilst chapter 10 " Discuss its Treatment." The Appendix is taken up by cas illustrating the portraits on the frontispiece. The latter contains " Types of Insanity,
" from photographs taken in the Devon County Lunatic Asylum. Following the first portion of the Appendix are cas bearing upon the " Treatment, Causa. tion, and Pathology of Mental Affections."
The whole work is marked by completeness and ability of no common order; and we had a right to expect much from the authors, who are in their speciality men of mark. If we have in our perusal of their " Manual" felt dispod to be critica it is with Dr. Bucknill when he touches upon abstract ques-tions. The, we are of opinion, are not hisforte. At p. 355 he takes the " opportunity to state with distinctness our views of the nature of pathological conditions not only in the brain, but in all the organs of the body." Now, in the argument which follows, two questions are, it appears to us, mixed up together. The first is, whether the starting point in most dias not of a traumatic character, be a change of function-i. e., of force or power, or a change in the textural quality of, or relative position in, the atoms of matter, and to which dynamic states succeed. The cond question is. whether.
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