against the breast of an assistant, who, at the same time, pressed upon
the labial arteries. The inferior lip was divided perpendicularly, and
detached laterally from the inferior jaw, so as to expose the whole
extent of the carcinoma. Some strokes of the saw were made on the
anterior and most prominent part of the bone, and into the groove thus
formed, the blade of a very strong knife was inserted, by means of
which, aided by some slight strokes with a mallet, all the diseased
portion was removed. The soft parts had been previously detached from
the internal surface of the jaw. The last left molar tooth, not being
diseased, was alone left. The haemorrhage from the dental artery was
arrested by the actual cautery.
The dental arch of the upper jaw, was then completely removed in the
same manner. The bleeding was here more profuse, but was arrested by a
hot iron. The alveolar processes thus removed, were enlarged, and of a
lardaceous colour, and the fungous growths had the appearance and
consistence of indurated albumen.
In 25 days, the patient was discharged well. Her general health was
good; the foetor had quite gone; the cicatrix over the bone was
regular, white, hard, and could be pressed upon without causing pain.
The patient can triturate her food with facility; the lips are slightly
drawn inwards, without any sensible inconvenience; and the voice is a
little altered, but this even is daily improving.--_Le Propagateur des
Sci. Med._ for Jan. 1826.
55. _Traumatic Erysipelas._--In the Feb. No. of the Revue Medicale, is a
clinical report of the celebrated Baron LARREY, surgeon in chief of the
Hospital de la Garde Royale; in which he criticises severely the use of
leeches in erysipelas, and recommends in that variety of the disease,
arising from wounds, &c. the application of the actual cautery, as
effectual in arresting immediately the progress of the disease. It
causes, he says, but little pain; destroys the burning and tense pain of
the disease, as also the redness and swelling of the part; is not
followed by suppuration, and does not cause gangrene in the contiguous
parts. The eschar separates, without leaving a cicatrix. Various other
advantages are enumerated, all of which are confirmed by a list of
cases, as treated at the hospital. We have no room for details, which
would, if known universally, hardly render us Americans, whether
surgeons or patients, as fond of the cautery, as our trans-atlantic
brethren of the French school.
56. _Obliteration of a portion of the Urethra, remedied by an
operation._--M. VANIER of Cherbourgh, relates in the Jan. No. of "Le
Propagateur des Sciences Medicales," the case of a man aged 27 years,
who, on the 16th of June, 1815, was wounded in the penis by a musket
ball, which completely divided the urethra at its middle portion,
without injuring the corpora cavernosa. The wound healed up; but by
degrees, the passage contracted, so that in May, 1819, the patient could
pass his urine only guttatim, with pain and difficulty, and was
threatened with inflammation, &c. of the perineum. Bougies afforded no
relief. An incision was then made externally, in the direction of the
urethra, so as to divide the cicatrix, and open the canal above and
below the contracted part. The lips of the incision were drawn together
over a sound, passed into the bladder; and by the 5th day, the wound was
completely cicatrized. The sound was then removed, and a short bougie
inserted, so as to pass beyond the cicatrix. This was worn occasionally,
and the patient completely recovered. At the end of three years, he was
able to "urinate with ease, and in a full stream."
57. _Artificial Joint cured by Caustic._--Dr. J. RHEA BARTON, has
applied the caustic potash to the extremities of the fragments of a
broken tibia, after an artificial joint had fully formed. Exfoliation
was produced, followed by bony union. In three months, the patient
recovered.
Dr. B. alludes to other cases, by Mr. WHITE of Manchester, and Mr. HENRY
CLINE, thus treated with success; to two instances, in which the
practice failed in the hands of Mr. EARLE; and finally, to one case by
Mr. A. COOPER, the result of which he has not learnt. He does not
recommend the operation, as usually preferable to the _seton_, for
which, the profession is indebted to Dr. PHYSICK; but as an additional
expedient, when other means fail.--_Med. Record. April_, 1826.
58. _Epilepsy cured by Trephining._--In the 17th No. of the New-York
Medical and Physical Journal, Dr. DAVID L. ROGERS relates an interesting
case of a man, aged 46, who had been subject to epileptic convulsions
for 14 years, and who, of late years, had been unable to labour, and
rapidly sinking into a state of idiocy, from their frequent recurrence.
These fits were preceded by a fracture of the os frontis, with
depression, from which he readily recovered; but soon after he was
attacked with convulsions. He now suffers pain on the injured side
extending down the neck and left arm--the eye of the same side is
diminished--the sight much impaired, and his memory almost entirely
destroyed. A cicatrix covering a slight depression was easily found,
above the left superciliary ridge of the frontal bone, and over the
superior orbitar foramen. Under these circumstances, the operation of
trephining was performed on the 7th of July, 1825, but with some
difficulty, from the irregular thickness of the bone, and from the saw
having to pass through the upper part of the frontal sinus. "The dura
mater was unfortunately cut through for one-half the circumference of
the circle." The parts were found more vascular than usual, and the
under surface had a ridge corresponding to the internal depression, but
too slight to have caused compression of the brain. "Having made a
section of the frontal sinus, [with a trephine?] a part of the
_posterior table_ was removed with the _circular_ piece. This portion of
the internal table had been fractured, and separated to some distance
from its inferior attachments to the frontal plate, and driven back upon
the substance of the brain. Its sharp edge was worn round and smooth."
This seemed to have been the cause of all the mischief.
After the operation, the patient suffered from pain in his head, with
some moderate excitement, which was relieved by cathartics. He had no
return of fits until the 25th day, when the wound was entirely healed.
These had been brought on by overloading his stomach with food, and were
followed by high arterial excitement and inflammation of the brain.
He was relieved in a few days by active depletion, and was discharged
cured on the 20th of August. _Nine months_ afterwards, this man
continued free from fits, his memory had nearly recovered its usual
strength, and he could attend to his business without any inconvenience.
VI. MIDWIFERY.
59. _Gastrotomy_.--M. BULK, in Germany, has successfully performed this
operation on a female, aged 36 years, of good constitution, under the
following circumstances. The patient, during her pregnancy, suffered
from a severe pain at the left and inferior portion of the abdomen; her
menses were not suppressed, and every six or eight days, a clot of blood
and mucus came from the vagina. Her general health was very good.
About the middle of her 8th month, she was washing some linen, and
suddenly felt as if something was tearing in her abdomen; at the same
time, a swelling of the size of two fists (poings) formed on the right
side, below the umbilicus. She fainted, and for six weeks suffered dull
pains in the abdomen. At this time, she had _true labour pains_ for 48
hours, and was attended by a midwife. The os uteri dilated so as to
admit one finger only. The tumour disappeared during these pains. The
patient recovered, with the size of the abdomen undiminished.
In this state she continued for two years and three months, menstruating
regularly. She became again pregnant, with little inconvenience until
the 7th month, when her abdomen was painfully distended, and of a bluish
colour, and fluctuation was induced on the least motion. At the full
period, she was delivered of a large foetus, which she suckled for 15
days. The infant then died of an aphthous affection.
Her milk ceasing, she rapidly declined with hectic symptoms. The tumour
reappeared below the umbilicus about the size of an egg, and soon
opened, discharging from small orifices a little pus. The opening was
enlarged, and some skin and hairs were removed. The patient's
constitution was fast yielding, and gastrotomy was immediately
performed. An incision was made, with the requisite precautions, through
the linea alba into the cavity of the abdomen, from two and a half
inches above the umbilicus to within nine lines of the pubis, care being
taken to prevent the escape of the intestines. A foetus of full size,
in which putrefaction had commenced, was found on the right side of the
uterus. "I raised," says the operator, "the body with much care, and
endeavoured to trace the umbilical cord. This was turned over the fundus
of the uterus to the left side, and terminated in a vascular substance
in a state of suppuration, (probably, the remains of the placenta,)
which was situated below the great omentum. I pressed out, and dried up
the pus, which covered these parts, by means of a sponge. The uterus was
an inch and a half in length and an inch in breadth, of a pale rose
colour, and could easily be distended (se laissait distendre aisement.)
It was otherwise in a good condition."
The wound in the abdomen was closed with sutures. The patient was in
great danger from inflammatory symptoms for 8 days, but eventually
recovered. She left her bed on the 55th day.
60. _Caesarian operation, performed with safety to the Mother and
Foetus._--We condense from JOHNSON'S Review for April last, the
following summary of a case of Caesarian section performed by GRAEFE, on
the 20th of September, 1825.
Carolina Bechang, was admitted into GRAEFE'S Clinicum, in an advanced
stage of pregnancy; being 30 years of age, much deformed by rickets, and
only four feet (Rhenish) in height. On the 20th of Sept. after having
been five days in labour at the full period, pains severe, and os uteri
dilated, she consented to the Caesarian section.
A little after 2 o'clock, GRAEFE placed the fore finger of his left
hand, immediately below the umbilicus, and with a large scalpel, made an
incision downwards in the linea alba, to within one inch of the pubis;
dividing the entire parietes, and even penetrating the substance of the
uterus. A second incision penetrated the uterus and exposed the
placenta; which, as had been anticipated, was found on the fore part of
the fundus. The assistants now compressed firmly the edges of the
divided abdominal parietes upon the uterus, to prevent the protrusion of
the intestines, in which they succeeded; and GRAEFE carried his hand in
a moment into the uterus, separated the placenta with his finger and
thumb, and then withdrew it and the child almost together. The child was
very active, and cried lustily. The uterus immediately and suddenly
contracted, and the bleeding was inconsiderable. Not more than twelve
ounces of blood were lost, and no ligature was required. The whole
operation was completed in four minutes and a half. The wound was
secured by three broad sutures, and adhesive plasters, assisted by a
bandage round the abdomen. The child weighed six pounds and was well
formed. During the operation, the patient was sick, and once vomited
slightly. In two hours had pain and fever: V.S. [Symbol: ounce]xij.
Draught with ten drops of the aqua laurocerasi was given, and repeated
in a few hours. The patient passed a quiet night. The symptoms of pain,
inflammation, and fever, were threatening for some days, and were
promptly resisted by the lancet, by enamata, by narcotics, especially
the laurocerasus and hyosciamus, by fomentations, &c. By the 9th day,
the wound had cicatrized, excepting near the symphisis; symptoms all
favourable. The lochia were discharged regularly; and in three weeks,
she was able to sit up, and in three more, quite well. Early in
November, she returned home with her child, both in perfect health.
In FERUSSAC'S Bulletin Universel; for February, another case, in which
the Caesarian operation was performed with safety to the mother and
infant, is copied from RUST'S Magazine.
61. _Extirpation of the Uterus._--Dr. RHEINECK, of Memmingen, was
consulted by a female, who in December, 1824, was attacked by fever,
from which she slowly recovered. A prolapsus of the uterus, which
gradually became inverted, followed, attended with frequent haemorrhage
and discharge, by which she was almost worn to the grave. The whole of
the uterus was inverted, and without the labia externa; its surface
loose, fungous, and in several places easily broken down upon pressure;
but there was no hardening nor ulceration. The irritation was so great,
as to threaten the patient's life, and after a consultation, in which it
was agreed, that the swelling was really formed by the uterus, the
tumour was laid hold of and drawn forwards, and a broad ligature,
secured with a double surgeon's knot, was applied round its base. In
about three weeks, the whole had separated, and the part above the
ligature was cicatrized. During this period, the patient was dangerously
ill, and was only rescued by great care and attention.
The operator had before performed a similar operation, in which case,
the patient died suddenly from haemorrhage, on the separation of the
ligature. OSIANDER, STRUVE, LONGENBACK, SAUTER, SIEBOLD, and ZAUG, have
in late years performed the same operation, with various degrees of
success.--_Johnson's Review for April_, 1826, who quotes from _Siebold's
Journal fur Geburtshulfe_, 1826.
62. _Uterine Haemorrhage._--In the Bulletin Universel for Jan. 1826, the
following case is detailed from the Gazette de Sante, for Dec. 1825.
A female aged 32 years, was taken with labour with her first child, on
the 12th Feb. 1825. The pains soon ceased, and on the 15th of Feb. M.
BEDEL, physician at Schirmack, was consulted, who speedily delivered
her, by means of the forceps, of a dead child. The haemorrhage was so
considerable, as to render the immediate removal of the placenta
necessary; but the uterus did not contract, and the bleeding continued,
with tremblings, syncope, cold sweats, &c. Irritation on the internal
surface of the uterus, the use of cold water to the abdomen, injections
into the uterus of cold water and vinegar, were unavailing.
Plugging the vagina, and also the _uterus_, was now resorted to, as the
only means of safety remaining. The uterus was filled with pieces of
rags, for fear the patient could not sustain the loss of blood necessary
to fill that cavity; while a methodic compression was at the same time
made to the abdomen. The haemorrhage was immediately arrested, and soon
after reaction ensued.
On the 16th, M. BEDEL extracted the plugs from the uterus, cautiously
and in succession; and had the pleasure of finding the uterus regularly
contracting after each removal. The lochial discharge continued, and
there was no secretion of milk. The patient recovered slowly.
It is in such cases as the above, that the physicians of the United
States have employed the Secale Cornutum (Ergot,) the judicious use of
which would have probably superseded the necessity of instruments, and
prevented or arrested the haemorrhagic discharge.
VII. CHEMISTRY AND PHARMACY.
63. _State in which Morphia exists in Opium._--In the 80th article of
our Quarterly Summary for January, we stated that MR. ROBINET had
announced the discovery of a new acid in opium, with which the morphia
was combined; while the meconic acid was alleged to be united with soda.
To the former salt, he gave the name of _codeate of morphia_. MR.
ROBIQUET, however, has shown, that the pretended _codeate_, is a
_muriate_ of morphia, formed by double decomposition between the muriate
of soda, employed by MR. ROBINET in his analysis, and meconate of
morphia. The same decomposition shows the source of the meconate of
soda. We observe that MR. ROBINET admits his mistake.--_Archives
Generales de Medicine._
64. _Peculiar principles of Narcotic Plants._--"Dr. BRANDES of
Sabzerflen, having been prevented by extreme illness, induced by
investigating the peculiar principles of narcotic plants, from
completing his inquiries, has announced the results of his labours in
general terms. He states, that he has found a peculiar narcotic
principle in all the narcotic plants; as belladonna, hyosciamus, conium,
stramonium, chelidonium, digitalis, &c. The narcotic principles are
readily soluble in alcohol, ether, acids, and water, and of a highly
offensive odour. This odour is so great in the principle of conium, that
it is almost impossible for an individual of an irritable habit, to
remain in the room, where there is an etherial solution, containing only
a few grains of it. The smell of such a solution is equal to the smell,
arising from twenty or thirty pounds of the plants. It is also
remarkable, that as this principle is neutralized by acid, the
disagreeable odour disappears, or is greatly diminished; which so far
agrees with the circumstance, that the plants themselves give little of
their peculiar smell, because the narcotic principle is not in a free
state. Dr. BRANDES has promised to communicate the manner of obtaining
the principles."--_Lond. Med. Repository, Feb. 1826._
65. _Relative quantities of Cinchonia and Quinia in the most esteemed
Varieties of Peruvian Bark._--Mr. BALLY asserts, that practitioners,
from observation, have classed the Peruvian barks in the following
order;--first, the gray loxa bark, (_Cinchona Officinalis_;) then the
red bark (_Cinchona Magnifolia_ of RUIZ and PAVON, or _Oblongifolia_ of
MUTIS;) and lastly the yellow bark, or calisaya, (_Cinchona Cordifolia_
of MUTIS, or _pubescens_ of VALLI.) The _Cinchona Officinalis_ furnishes
much cinchonia, and little quinia; the _Cinchona Magnifolia_ affords
about equal quantities of the two salifiable principles, while the
_Cordifolia_ contain much quinia.
Mr. BALLY, assuming it as proved, that cinchonia is the more powerful
salifiable base of the two in a medical point of view, considers,
therefore, that, in regard to the above barks, chemical analysis
justifies the order of their relative value, which had been previously
deduced from their medical employment.--_Archives Generales de
Medecine._
66. _Sulphate of Quinia, extracted from the Cinchona Bark, exhausted by
Decoction._--Mr. JULIA-FONTENELLE, from the sparing solubility of quinia
and cinchonia, suspected that decoctions and aqueous extracts of
Peruvian bark contained but little of those vegetable alkalies; whence
it would follow, that the residuum, generally rejected as having no
febrifuge power, would still contain the greater part of them. This
suspicion has been in a great measure verified. The aqueous extract was
found to contain but little cinchonia and quinia; while the residuum of
decoctions, giving the mean results, furnished two-thirds of the
sulphate of quinia, yielded by the same weight of cinchona not acted on
by water.
As decoctions and aqueous extracts of bark are febrifuge, though
containing inconsiderable quantities of quinia, and cinchonia, Mr.
JULIA-FONTENELLE is led to believe, that these salifiable bases are not
the only febrifuge principles in Peruvian bark, but that the extractive
matter also possesses that property.
His results present a striking difference between alcoholic and aqueous
extracts of bark; for while the former contain nearly the whole of the
salifiable principles, the latter contain very little.--_Revue
Medicale._
67. _Analysis of Rhubarb._--It is some time since Mr. NANI, an Italian
chemist, announced the discovery of a crystallizable vegetable alkali in
rhubarb. Mr. CAVENTOU has repeated the experiments of Mr. N. and finds
them, in many respects, inaccurate. Upon analysing the alcoholic extract
of rhubarb, by the aid of alcohol and ether, employed separately and
combined, Mr. C. obtained a fatty matter, containing a little
odoriferous volatile oil, and a yellow colouring principle, capable of
crystallization, and of being sublimed without decomposition, which may
be called _rhubarbin_. He also detected in the alcoholic extract, a
brown substance, insoluble in water when pure, but rendered soluble by
combination with rhubarbin; when it forms a compound, constituting the
_eaphopicrite_ of some chemists, and the _rhubarbin_ of
Psaff.--_Archives Generales._
Mr. GEORGE W. CARPENTER, of this city, prepares the medicinal principle
of rhubarb in combination with sulphuric acid, under the name of
sulphate of rhubarb, by the following process:
"Boil, for half an hour, six pounds of coarsely powdered Chinese rhubarb
in six gallons of water, acidulated with two and a half fluid ounces of
sulphuric acid; strain the decoction, and submit the residue to a second
ebullition in a like quantity of acidulated water; strain as before, and
submit it again to a third ebullition. Unite the three decoctions, and
add, by small portions, recently powdered pure lime, constantly stirring
it to facilitate its action on the acid decoction. When the decoction
becomes slightly alkaline, it deposites a red flocculent precipitate,
and the fluid is changed from a yellow to a crimson colour. The
precipitate is then to be separated by passing it through a linen cloth,
and dried; after which, reduce it to powder, and digest in three gallons
of alcohol, at thirty-six degrees, in a water bath, for several hours,
at a moderate heat. Separate this solution from the calcareous
precipitate, and distil off three-fourths of the alcohol. There then
remains a strong solution of rhubarbine, to which add as much sulphuric
acid as will exactly neutralize it. Evaporate this slowly to dryness,
without having access to atmospheric air. The residuum will be of a
brownish-red colour, intermingled with brilliant specks, possessing a
slightly pungent styptic taste, soluble in water, and its odour that of
the native rhubarb." This residuum is the sulphate of rhubarb. (Sulphate
of _rhubarbin._?)
Mr. CARPENTER assures us, that this preparation contains the medicinal
principle of the rhubarb, apart from its inert portion; and considers it
as bearing the same relation to rhubarb, as the sulphate of quinia to
the Peruvian bark. The Chinese rhubarb, at half the price, furnished
twice as much rhubarbin as the reputed Russian, which Mr. C. considers
to be spurious in the Philadelphia market, being the English prepared in
imitation of the Russian.--_Philadelphia Journal of the Medical &
Physical Sciences. May_, 1826.
68. _Alkaline Lozenges of Bicarbonate of Soda._--Mr. D'ARCET proposes
the following formula for these lozenges:--Take of
Bicarbonate of Soda, pure and dry, and in fine powder, 5 parts.
Very white Sugar, in fine powder, 95
Mucilage of Gum Tragacanth, q.s.
Essential oil of Mint, pure and fresh, 2 or 3 drops
for about every 3 ounces of mixture of bicarbonate and sugar.
Shake the bicarbonate and sugar in a well dried bottle, with the view of
mixing them intimately. Withdraw the mixture from the bottle, and add
the mucilage and oil of mint, blending the whole together on a marble.
The mass obtained, is then to be divided into lozenges, which should
weigh, when dried, about 15 grains each. As they slightly attract
moisture, they ought to be kept in a dry place, or in well stopped
bottles.