Hunterian preparations were merely the result of extravasation, a rather
hazardous conclusion against the authority of such men as the Hunters. Mr.
J. Hunter has, however, expressly met this objection in the following
observation:--"this substance of the placenta, now filled with injection,
had nothing of a vascular appearance, or that of extravasation; but had a
regularity in its form which showed it to be a natural cellular structure,
fitted to be a reservoir for blood." (_Observations on Certain Parts of
the Animal Economy_, p. 129.)
[23] In offering these observations on the placenta, we have purposely
quoted, wherever it was possible, from the admirable essays of the
Hunter's, on this subject. These works, more especially that of Dr. W.
Hunter, are becoming too scarce to be easily attained by the student; and
yet it is more peculiarly important to this class of our readers, that
they should not only be aware how much we are indebted to these
illustrious men for what we know upon the subject; but also that they
should be as familiar as possible with their very words and expressions.
The essays in question are master-pieces of original observation and
correct description, and we may safely assert, that the one by Dr. Hunter
is so complete, as to leave us little or nothing more to be wished for on
this subject. With such feelings we cannot conceal our surprise, to find
that an author like Dr. Burns should have passed over the whole subject of
the placenta without once alluding to the name of Hunter; this omission is
the more marked in the last editions of his work, where he has furnished
the reader with copious references, &c. in the notes. One would have
thought that Dr. Burns would have felt pride in acknowledging the merits
of his distinguished countrymen.
[24] We said, "_one_ of the earliest changes." Mr. Jones considers that
"the breaking up of the surface of the yelk into crystalline forms," is
the first change which he has observed.
[25] Allen Thomson on the Development of the Vascular System in the Foetus
of Vertebrated Animal. (_Edin. New Philosop. Journ._ Oct. 1830.)
[26] Pander. Beiträge zur Entwickelungs-gesechichte des Hünchens im Eie.
Würzburg, 1817.
[27] In making these observations upon the formation of the ductus
arteriosus, we must request our readers to consider this as still an
unsettled question.
[28] The vernix caseosa is a viscid fatty matter of a yellowish white
colour, adhering to different parts of the child's body, and in some cases
in such quantity as to cover the whole surface; it seems to be a substance
intermediate between fibrine and fat, having a considerable resemblance to
spermaceti. From the known activity of the sebaceous glands in the foetal
state, and from this smegma being found in the greatest quantity about the
head, arm-pits, and groins, where these glands are most abundant, there is
every reason to consider it as the secretion of the sebaceous glands of
the skin during the latter months of pregnancy.
[29] Fourcroy, it is true, has shown that the foetal blood is not only of
a darker colour, but incapable of becoming reddened by the contact of
atmospheric air, and that it coagulates very imperfectly. Others have
shown that there is no perceptible difference in the colour of the blood
of the umbilical arteries from that of the umbilical vein. Still, however,
this by no means disproves what we have now stated, and which is now
generally allowed to be the office of the placenta during the latter
periods of pregnancy.
[30] "A gentleman," says Dr. Montgomery, "lately informed me that, being
afflicted with a stepmother naturally more disposed to practise the
_fortiter in re_ than to adopt the _suaviter in modo_, he and all the
household had learned from experience to hail with joyful anticipations
the lady's pregnancy, as a period when clouds and storms were immediately
changed for sunshine and quietness." (_Exposition of the Signs and
Symptoms of Pregnancy_, p. 9.)
[31] _Dionis_ says, that "women of a sanguine complexion, who form more
blood every month than is necessary for the nourishment of the foetus
whilst it is small, discharge the overplus by the vessels which open into
the vagina during the first months."
[32] The menstrual blood is more pale and sparing: it usually comes from
the hæmorrhoidal vessels of the vagina, or at most, from those of the
cervix uteri. (Levret, _Art des Accouchemens_, § 233.)
[33] Should the vessels of the cervix uteri take upon them the secretion
of the menses, this discharge can thus continue through pregnancy. (Carus,
_Lehrbuch der Gynakologie_, bd. ii. p. 67.)
[34] L'Art d'Accouchemens, § 369. (note;) also Deventer, Novum Lumen
Obstet. chap. xv.; Perfect's Cases of Midwifery, vol. ii. p. 71. [Meurer,
American Journ. Med. Sc., April 1841, p. 494.]
[35] This fact was observed so long ago as by Aristotle, also by Schenk,
as quoted by Mauriceau, lib. i. chap. 1. Mauriceau himself mentions having
seen several cases, one of which forms the subject of his 393d
observation. "Le 8 Juin, 1685. J'ai vu une jeune femme agée seulement de
seize ans et demi, marié depuis un an qui était grosse de cinq mois ou
environ, quoiqu'elle n'eut jamais eu ses menstrues, à ce qu'elle me dit
aussi bien que son marie, qui ne pouvait pas se persuader qu'elle cût pû
devenir grosse, n'ayant pas encore eu ce premier signe de fécondité;
m'alleguant, pour soutenir son opinion, qu'on ne voyait jamais de fruit
d'un arbre qui n'eut été précédé de sa fleur. Mais je lui dis qu'il était
certain, comme il reconnut bien par sa propre experience en voyant
accoucher sa femme d'un enfant vivant quatre mois ensuite, que les jeunes
femmes pouvaient bien quelquefois devenir grosses, ainsi qu'il était
arrivé à sa femme, sans avoir jamais eu leur menstrues, si elles usaint du
coit dans le temps méme quelles étaient sur le point d'avoir effectivement
cette evacuation naturelle pour le premier fois."
[36] Roederer, Elm. Art. Obst. p. 46. The original is a masterly specimen
of description, not less remarkable for its singular comprehensiveness
than the beauty of the style. "Menstruorum suppressionem mammarum tumour
insequitur, quocirca mammæ crescunt, replentur, dolent interdum,
indurescunt; venæ earum coeruleo colore conspicuæ redduntur; crassescit
papilla, inflata videtur, color ejusdem fit obscurior; simili colore
distinguitur discus ambiens qui in latitudinem majorem expanditur,
parvisque eminentiis quasi totidem papillulis tegitur."
[37] "In women with dark eyes and hair, this discolouration is very
distinct; in women with light hair and eyes, it is often so slight that it
is difficult to tell whether it exists or no."... "In brunettes who have
already borne children, the areola remains dark ever afterwards, so that
this ceases to be a guide in all subsequent pregnancies." (Gooch, _on some
of the more important Diseases of Women_, p. 201 and 203.)
[38] We had, at the moment of writing the above, a patient just recovered
from her first labour, in whom the discolouration extended nearly over the
whole breast: it was darker in some spots than in others, and presented a
variety of shades not unlike a large bruise of some days' standing. Dr.
Montgomery mentions a case where the areola was almost black, and upwards
of three inches in diameter. A similar case occurred not long since.
[39] Bibliothèque Universalle, t. ix. p. 248; also in the Isis for 1819,
part iv. p. 542.
[40] "Mémoir sur l'Auscultation appliquée à l'étude de la Grossesse, ou
Recherches sur deux nouveaux Signes propres à faire reconnaïtre plusieurs
Circonstances de l'Etat de Gestation; lu à l'Academie Royale de Médecine
dans la Séance Générale du 26 December, 1821. Par J. A. Lejumeau de
Kergaradec."
[41] Dr. Evory Kennedy, Observations on Obstetric Auscultation, &c. 1833.
[42] H. F. Naegelé, Die Geburtshülfliche Auscultation, 1838; also Dr.
Corrigan, Lancet.
[43] Die Geburtshülfliche Exploration, von Dr. A. P. Hohl.
[44] This sign of pregnancy has very recently excited some attention, and
the researches of M. Tanchou of Paris, (see _American Journ. Med. Sc._
Feb. 1840, p. 483,) Golding Bird, (_Ibid._, Aug. 1840, p. 501,) and Drs.
McPheeters and Perry, (_American Medical Intelligencer_, March 15th, 1841,
p. 350,) conclusively establish, that taken in connexion with other
symptoms, it forms a very valuable aid to diagnosis.
The following is the description given by M. Tanchou of the changes which
the urine during pregnancy exhibits, and of the characters by which its
peculiar ingredient, named by M. Nauche _Kiesteine_, may be recognised.
The urine of a pregnant woman, collected in the morning, is usually of a
pale yellow colour and slightly milky in appearance; it is not coagulable
by heat, or by any of the tests which indicate the presence of albumen.
Left to itself and exposed to the air after the first day, there begins to
appear suspended in it a cottony-looking cloud, and, at the same time, a
flocculent whitish matter is deposited at the bottom of the fluid. These
phenomena are not of constant occurrence, and, moreover, healthy urine
sometimes exhibits analogous phenomena.
From the second to the sixth day, we perceive small opaque bodies rise
from the bottom to the top of the fluid; these gradually collect together
so as to form a layer which covers the surface: this is the _kiesteine_.
It is of a whitish or opaline colour, and may be very aptly compared to
the layer of greasy matter which covers the surface of fat broth, when it
has been allowed to cool. Examined by the microscope, it exhibits the
appearance of a gelatinous mass, which has no determinate form. Sometimes
small cubical crystals can be perceived in it, when it has become stale.
The _kiesteine_ continues in the state we have now described, for three or
four days; the urine then becomes muddy, and minute opaque bodies detach
themselves from the surface and settle at the bottom of the vessel: the
pellicle thus becomes soon destroyed.
The characteristic feature, therefore, of the urine during pregnancy
consists in the presence of _kiesteine_. It deserves, however, to be
noticed, that the urine, in some cases of extreme phthisis pulmonalis, and
also of vesical catarrh, will be found to exhibit on its surface a layer
or stratum which is not unlike to that now described as peculiar to the
state of pregnancy. But with proper attention we may easily avoid this
mistake. The stratum, in the cases alluded to, does not appear so quickly
on the surface of the urine as the _kiesteine_ does; and also, instead of
disappearing, as it is found to do, in the course of a few days, it (the
former) goes on increasing in thickness, and ultimately becomes converted
into a mass of mouldiness.
Of twenty-five cases, in which M. Tanchou detected the presence of
_kiesteine_ in the urine, seventeen occurred in women who were pregnant
from four to nine months, four in women who had not quickened, and who
considered themselves as labouring under disease of the womb, and the
remaining four in patients who had been under treatment for casual
complaints--one for sciatica at the Hôtel Dieu, another for ascites in the
city, a third for an ulcer in the neck at La Pitié, and the last had been
cauterized twice a week for a pretended disease of the uterus. In none of
these cases had the existence of pregnancy been suspected, although in
every one of them the fact was soon placed beyond doubt.--EDITOR.
[45] Baudelocque wrote an account of it to Professor Naegelé of
Heidelberg, from whom we received the particulars.
[46] See Treatise on the Diseases of Females, 6th ed. p. 46. Ed.
[47] Ovum deforme, in quo partes embryonis et secundarum distingui vix
possunt, molam vocabimus. (Roederer, _Elementa Artis Obstetricæ_, § 738.)
[48] Dr. J. Y. Simpson on the Diseases of the Placenta. (_Edin. Med. and
Surg. Journal_, April 1, 1836.)
[49] "One must be careful not to mistake these clots of blood, which being
washed by the reddish serosities which flow from the womb, harden in the
vagina, or womb itself, and look exactly like false conceptions." (_La
Motte._)
"Every mole is a blighted ovum which has been the product of conception.
We are not justified in classing under the head of moles every mass which
is produced and lodged within the uterus." (Froriep's _Handbuch der
Geburtshülfe_, § 180.)
[50] Our friend, Dr. Nebel, of Heidelberg, has a preparation of a foetus
which was retained for fifty-four years in the abdomen. This is the
longest period on record of a foetus being retained in the cyst of a
ventral pregnancy. Many other cases have been described. (See _Burns_, 9th
edition, where the notes contain very ample references.)
[51] We had lately a case of this kind. The patient had been under our
care for inflammation of the cervix uteri. There was that general
enlargement of the uterus which attends this condition; and, on
endeavouring to lift a heavy weight, she was seized with violent pain in
the pelvis, great difficulty in passing fæces and urine, and, on
examination, the uterus was found retroverted. The bowels were well opened
with castor oil, and in a day or two it recovered its natural position.
[52] Dr. W. Hunter has evidently taken the same view of the case, and
invariably considers retention of urine as an effect, not the cause, of
this displacement. (_Med. Observ. and Inq._ vol. iv.)
[53] We were once misled in a case of this description. The os uteri lay
close behind the symphysis pubis, and its opening, as well as so much of
the neck as we could feel, looked straight downwards. We were unable to
pass the finger sufficiently high to trace the continuity between the neck
of the uterus and tumour in the hollow of the sacrum formed by the fundus;
and the haggard aged appearance of the woman put all suspicion of
pregnancy out of our mind.
[54] Dr. Burns makes a similar observation. "In most cases the cervix will
be found more or less curved; so that the os uteri is not directed so much
upwards as it otherwise should be." (_Principles of Midwifery_, p. 281.
9th edit.)
[55] "Sometimes it is perhaps better to introduce the fingers into the
vagina only, and not into the rectum, not merely because, we can act
better and more directly upon the uterus here, but also because if we
press the posterior wall of the vagina upward towards the sacrum, and thus
stretch the upper part of it which is between the fingers and the os
uteri, it will act upon the uterus like a cord upon a pulley, and greatly
favour its rotation." (Richter, _op. cit._ vol. vii. sect. 57.)
[56] Among others, we may mention an exceedingly interesting case recorded
by Mr. Baynham, in the _Edin. Med. and Surg. Journ._ April, 1830. The real
nature of the case was not ascertained for six weeks, the catheter only
being used night and morning. Even when the bladder was empty, the fundus
resisted every attempt to return it. The most prominent part of the tumour
in the rectum was punctured with a trocar, and about twelve ounces of
liquor amnii, without blood, were drawn off: the reduction followed in
about a quarter of an hour. A full opiate was given, and the patient
passed a better night than she had done before. Twenty-five hours after
the operation, the foetus, was expelled; it was fresh, and about the size
of a six months' child. The patient recovered.
[57] Dr. Cheston's case, where the child was afterwards carried the full
time, and born alive. (_Med. Communications_, vol. ii. p. 6.)
[58] Merriman, Med. Chir. Trans. Vol. xiii. p. 338.
[59] Exposition of the Signs and Symptoms of Pregnancy: by W. F.
Montgomery M. D. p. 253.
[60] Dewees, Compendious System of Midwifery, sect. 408. A similar case is
recorded by Dr. Montgomery.
[61] "Qui inter septimi et noni mensis, à prima conceptione, finem
contingit partus, _præmaturus_ vocatur: _abortus_ vero quando ante dictum
tempus embryo excidit; id quod circa tertium graviditatis mensem ut
plurimum accidit. Vitalem esse præmaturum foetum observatio nos docet,
embryonem autem non manere superstitem constat." (Roederer, _Elem. Artis
Obst._ cap. xxiii. § 716.)
[62] During the great influenza epidemic, abortions were remarkably
frequent.
[63] This is nearly the same arrangement which has been followed by Dr.
Copland, in the article ABORTION, in the Dict. Pract. Med.
[64] This crotchet consists of a piece of steel of the thickness of a
small quill at its handle, and gradually tapered off to its other
extremity which is bent to a hook of small size. (See accompanying figure
which represents the instrument one third the natural size.)
[Illustration]
This instrument is highly useful in cases in which the flooding continues
after the ovum has been broken and its contents expelled. A portion of the
involucrum sometimes insinuates itself into the neck of the uterus, and
prevents the degree of contraction necessary to interrupt farther
bleeding. This accident most frequently attends the earlier abortions. As
hæmorrhage is maintained by the cause just named it suggests the propriety
of never breaking the ovum; especially before the fourth month. When the
flooding is maintained by this cause, it will not cease but upon the event
of its removal. This condition of the placenta and neck of the uterus is
easily ascertained by an examination; it will readily be felt to be
embraced by the neck of the uterus; and though a portion may protrude a
little distance below the os tincæ, it cannot be extracted by the fingers;
for the os uteri or cavity of the uterus will not be sufficiently large to
permit the fingers to pass into it, that this mass may be removed; the
crotchet should then be substituted; the mode of using it is as
follows:--The fore-finger of the right hand is placed within or at the
edge of the os tincæ; with the left we conduct the hooked extremity along
this finger, until it is within the uterus; it is gently carried up to the
fundus, and then slowly drawn downwards, which makes its curved point fix
in the placenta; when thus engaged, it is gradually withdrawn, and the
placenta with it.
Dr. Dewees says, that in every case in which he has used this crotchet,
the discharge instantly ceased. See Art. "ABORTION," by Dr. Dewees, in
_American Cyclopedia of Pract. Med. and Surg._ Dr. Dewees "from some late
experience is induced to believe" that "in cases in which we cannot
command the removal of the placenta by the fingers--that is, when this
mass continues to occupy the uterine cavity, or but very little protruded
through the os tincæ," the administration of ergot, will often supercede
the necessity of the crotchet. _Treatise on the Diseases of Females._
Sixth Edition, p. 351.--ED.
[65] Dr. Dewees recommends the crotchet only where the flooding continues
_after_ the ovum has been broken. See preceding note. ED.
[66] "Clysteres injiciantur, quorum irritatione expultrix uteri facultas
excitatur, et depleta intestina ampliorem locum utero relinquat."
(Riverius, _Prax. Med. de Partu difficili_.)
[67] [Dr. Dewees recommends the woman to be placed for labour on her left
side at the foot of the bed, in such a manner as will enable her to fix
her feet firmly against one of the bed-posts; her hips within ten or
twelve inches of the edge of the bed; her knees bent, her body well flexed
upon her thighs; her head and shoulders will then be near the centre of
the bed, where pillows should be placed to raise them to a comfortable
height. This is the position we believe in which the patient is very
generally placed in the United States.--ED.]
[68] [See an interesting paper "on Laceration of the Perineum during
Labour; by Wm. M. Fahnestock, M. D.," in American Journal of the Med. Sc.
for Jan. 1841. Editor.]
[69] See a case of central perforation of the perineum, _Med. Gaz._ p.
782. Aug. 19, 1837.
[70] "The practice of using force to hurry the shoulders and body of the
child through the os externum as soon as the head was born, is very
generally laid aside. There can be no doubt that this imprudent conduct
often brought on a retention of the placenta." (See White, _on Lying-in
Women_.)
[71] "A ligature upon the navel string is absolutely necessary, otherwise
the child will bleed to death; and when tied slovenly, or not properly, it
will sometimes bleed to an alarming quantity. As we take such vast care to
secure the navel string, you will naturally ask how brutes manage in this
particular? I will give you an idea of their method of procedure, by
describing what I saw in a little bitch of Dr. Douglas. The pains coming
on, the membranes were protruded; in a pain or two more they burst, and
the puppy followed. You cannot imagine with what eagerness the mother
lapped up the waters, and then, taking hold of the membranes with her
teeth, drew out the secundines; these she devoured also, licking the
little puppy as dry as she could. As soon as she had done I took it up,
and saw the navel string much bruised and lacerated. However, a second
labour coming on, I watched more narrowly, and as soon as the little
creature was come into the world I cut the navel string, and the arteries
immediately spouted out profusely; fearing the poor thing would die, I
held it to its mother, who, drawing it several times through her mouth,
bruised and lacerated it, after which it bled no more. This, I make no
doubt is the practice with other animals." (Dr. W. Hunter's _Lectures, MS.
1752_; from Dr. Merriman's _Synopsis_, p. 21. note.)
[72] Carus's Gynakologie, vol. ii. p. 138. This assertion, however, must
be qualified, somewhat, as we know of several cases where flooding has
come on after labour during sleep.
[73] "I have observed," says Dr. Hunter, "in women who do not give suck,
and in nurses after they leave off suckling, that the axillary glands
become painful, swell, and sometimes suppurate. Is not this owing to the
acrimony which the milk has acquired by long stagnation in the breast, and
affecting the gland through which it must pass in absorption? I have
observed that they are at the same time liable to little fevers of the
intermitting kind, which come on with a rigour, and go off with a sweat.
Are not such fevers raised by absorption of acrid milk?" (Hunter's
_Commentaries_, p. 59.)
[74] [The best application we have ever tried, is the vinegar and water as
is commended by Dr. Dewees. See his admirable chapter on Milk Abscess.
_Treatise on the Principal Diseases of Females._--AM. ED.]
[75] [Sore nipples is an affection, of so very frequent occurrence, often
so exceedingly obstinate, and sometimes productive of such extreme torture
to the patient, that some additional remarks relative to its treatment may
be acceptable to the practitioner.
The solution of nitrate of silver, two grains to the ounce of water, is
highly extolled by MR. ALLARD (_American Journ. Med. Sc._ Feb. 1837,) and
DR. CHURCHILL says that he has found it the most effectual application.
(Diseases of _Pregnancy and Child-bed_.) This solution should be applied
every time the child is taken from the breast, care being taken to wash
the nipple previous to the next application of the child. We have
frequently found this treatment very efficacious, but in some cases it
entirely fails. Dr. Hannay says, that the solution is inferior to the
solid nitrate of silver, and asserts that the latter never fails to afford
relief and ultimately effect a cure. He uses it as follows. The nipple is
to be gently and carefully dried, then freely touched with a sharp pencil
of nitrate of silver, care being taken to insinuate the pencil into the
chaps or chinks. The nipple is then to be washed with a little warm milk
and water. The pain though smart soon subsides, and all that is necessary,
according to Mr. H. to heal the sore, is a little simple ointment, or one
made with the flowers of zinc. When the pain from the application is very
severe, relief should be given by the administration of thirty drops of
the solution of morphium. In some cases it is necessary to apply the
caustic more than once. (_Am. Journ. Med. Sc._ Feb. 1835, p. 527.)
DR. CHOPIN recommends repeated lotions with the solution of Chloride of
Soda, which he says will often cure in one or two days. (_Am. Journ. Med.
Sc._ May, 1836.)
DR. BARD says that simply keeping a linen cloth _constantly_ wet with rum
over the nipple is frequently very useful, and as it is one of the easiest
remedies, it should be first tried. (_Compendium of the Theory and
Practice of Midwifery._)
Stimulating ointments, such as ung. hydrarg. rub. diluted with lard, is,
according to BURNS, sometimes of service, as is also touching the parts
with burnt alum, or dusting them with some mild dry powder. Solutions of
sulphate of alumine and of sulphate of copper, of such strength as just to
smart a little, are also recommended as occasionally of service by the
last named practitioner. (_Principles of Midwifery_, 7th Ed. p. 543.)
We have found Kreosote, three to six drops in an ounce of water, very
efficacious; in some cases affording more speedy relief than any other
application. The mucilage of the slippery elm applied cold is often a most
comfortable application, and its efficacy is sometimes increased by
dissolving in it some borax.
When all these means fail, the mother must give up suckling for a time,
when the parts heal rapidly. This last resource will not be often
necessary.
The great number of remedies which have been employed for the cure of this
complaint sufficiently attest its obstinacy. This obstinacy is owing, in
some cases, we conceive, to an irritable condition of the patient's
system, a fact overlooked so far as we know, by most practitioners. In
such cases a mild and nutritious diet, fresh air, keeping the bowels free,
&c. will do more towards effecting a cure than local applications; though
the latter even here are not to be neglected. Editor.]
[76] [Dr. Dewees regards after-pains as an evil of magnitude, and always
endeavours to prevent them as quickly as possible. For this purpose he
recommends camphor or some preparation of opium. (See his _System of
Midwifery_.) We have always adopted this practice to the great relief of
the patient, and have never had cause to regret it. Dr. Dewees's
observations on this subject should be attentively perused.--ED.]
[77] See observations on MALPOSITION OF THE CHILD.
[78] We have no words in the English language like the _schrag_ and
_schief_ of the German to express these different species of obliquity.
[79] On the other hand, Dr. Merriman observes, that he has "twice known
the presentation of the face converted by the pains alone into a natural
presentation." (_Synopsis_, p. 48.)
[80] According to the results of Dr. Collins's experience at the Dublin
Lying-in Hospital, the face presented once in about every 504 cases; but
as, in several labours, the presentation was not noted on account of their
rapidity, the proportion is probably larger.
[81] Madame La Chapelle calls this the _courboure des bords_, to
distinguish it from the head curvature, _courboure des faces_ (p. 61.)
[82] A Treatise on the Improvement of Midwifery, chiefly with regard to
the Operation: by Edmund Chapman, 2d edit. 1735.
[83] [Dr. Dewees, prefers, in all cases, the long forceps. See the
chapters on the Forceps in his _System of Midwifery_. Ed.]
[84] See Midwifery Hospital Reports, case of Mrs. Worsley, May 3, 1834, p.
187.
[85] Another circumstance is humanely insisted on by Madame la Chapelle
with much propriety: "Je ne manque jamais de fair voir le forceps à la
femme, et de lui expliquer à-peu près son usage, et sa façon d'agir. Il
n'en est aucune que cette démonstration ne tranquillise, et j'en rencontre
souvent qui à leur deuxieme accouchement sollicitent l'application du
forceps qu'elles ont vu mettre en usage pour les débarasser du premier."
(_Pratique des Accouhemens_, p. 64.)
[86] Madame la Chapelle confirms this mode of introducing the forceps:
"Pour moi, je l'introduis constamment sur le ligament sacro-sciatique."
(_Pratique des Accouchemens_, p. 66.)
[87] "Quand une fois la tête est hors les parties osseuses, elle ne
retrograde plus, je les dêsarticule (the blades) avec la clef placée entre
elles en forme de lévier; je les extrais en les inclinant graduellement,
car souvent l'extraction un peu brusquée d'une branche produit l'expulsion
de la tête." (_La Chapelle._)
[88] "Mon avis est que la choix n'est point _nécessaire_ quand l'uterus
est encore rempli d'eau, et que la position est douteuse. En pareil cas je
conseillerais même plutôt de faire usage de la main droite, quoique, pour
mon compte, l'habitude m'ait rendu l'usage aussi familiar que celui de
l'autre." (Mad. la Chapelle, _Prat. des Accouch._ p. 88.)
[89] "Une chose très importante à observer quand on se trouve contraint
par la perte de sang à en venir à l'opération, et que les eaux ne sont
point encore ouvertes, c'est de couler la main tantôt à droit, tantôt à
gauche le plus haut et le plus doucement qu'il est possible de long les
membranes qui contiennent les eaux sans les rompre, jusqu' à ce qu' on ait
trouvé les pieds de l'enfant pour s'en saisir. Car s'il arrive qu'elles se
rompent avant qu'on ait pris cette précaution, pendant qu'on les cherche,
les eaux s'écoulent, les sang se perd, a la matrice se referme en partie,
et l'opération devient par-là plus difficile et plus dangereuse."
(_Pratique des Accouchemens_, p. 277.)
[90] Traité des Accouchemens, 1770. § 691. "Pour moi, j'ai toujours au
contraire trouvé un grand advantage à insinuer la main jusqu'aux pieds de
l'enfant, et à n'ouvrir les membranes qu'en saisissant ces derniers." (_La
Chapelle_ p. 90.)
[91] "We must by no means burst the bag of liquor amnii until the hand has
passed up between the membranes and the uterus. Every movement is easy
whilst there is fluid in the uterus: hence, therefore, we must not
withdraw the hand until we have fairly gained the feet and brought them
down; for otherwise the waters escape, the uterus contracts, and the rest
of the operation is more difficult." (_Boer_, vol. iii. p. 17. note.)
[92] "Je suis loin de prétendre, avec Puzos, que la traction sur un seul
pied ait les avantages récis." (_La Chapelle_, p. 93.)
[93] "Dans tous ces accouchemens je laisse le plus souvent agir la nature,
et je le fais avec bien plus de sécurité quand je sçais que la femme a
accouché précédemment et fort aisément d'enfans volumineux, quand je
reconnois son bassin pour avoir toutes les dimensions requises, quand les
contractions de la matrice sont bonnes." &c. (_Traité des Accouchemens_, §
674.)
[94] Ueber die künstliche Wendung auf den Steiss, in the Heidelberg Klin.
Annalen, vol. ii. part i. p. 142.
[95] Traité des Hernies, contenant une ample Déclaration, &c., par Pierre
Franco de Turriers en Provence, demeurant à presént à Orange: à Lyon,
1561.
[96] See DYSTOCIA FROM MALPOSITION OF THE CHILD. [The student who desires
to investigate this subject farther, may consult Dr. Churchill's
_Researches on Operative Midwifery_. Essay ii. on Version.--AM. ED.]
[97] [Prof. Gibson has operated twice on the same patient, and both times
successfully, for mother and children. See _American Journal_, for May
1838.--ED.]
[98] [Dr. Churchill has collected the statistics of 409 cases of Cæsarean
section, of which number, 228 mothers were saved; and 181 lost, or about 1
in 2-1/4: and out of 224 children, 160 were saved, and 64 lost--or about 1
in 3-1/2.
Of the above cases, 40 occurred in the practice of British practitioners,
of which, 11 mothers recovered, and 29 died; or nearly three fourths--and
37 cases, in which the result to the child is mentioned, 22 were saved,
and 15 lost--or 1 in 2-1/2.
Of 369 cases in the practice of Continental practitioners, 217 mothers
recovered, and 152 died, or 1 in 2-1/3--and out of 187 cases, where the
result to the child is given, 138 were saved, and 49 lost; or nearly 1 in
4. _Researches on Operative Midwifery._ By F. Churchill, M. D., Dublin,
1841. Editor.]
[99] [The propriety of an early resort to the Cæsarean section, in cases
where it is necessary, has been very properly insisted upon; but the
circumstances which render it necessary, are not always readily
determined. M. Castel states, that in a case at the _hospice de
perfectionnement_, in which the operation was determined on, some delay
became necessary in order to find accommodation for the crowd of students
who collected to witness it, and before this could be effected the woman
was delivered naturally. M. Gimelle says, that at the hospital of M.
Dubois, a small woman, who had five times submitted to the Cæsarean
section, was delivered naturally the sixth time. _Am. Journ. Med. Sc._
Aug. 1838. Ed.]
[100] For the particulars of this interesting case we must refer our
readers to the British and Foreign Med. Review, vol. ii. p. 270; and also
to vol. iv. p. 521. [Also to _American Journal Med. Sc._, August, 1838, p.
526, and Nov. 1837, p. 244.--ED.]
[101] [Those who desire farther information on this subject, may consult,
with advantage, Dr. Churchill's Researches, already quoted.--ED.]
[102] Dr. Macauley was physician to the British Lying-in Hospital, in
Brownlow Street, and colleague of Dr. W. Hunter.
[103] Barlow, Medical Facts and Observations, vol. viii. Although we are
in great measure indebted to Dr. Denman for having brought this operation
into general notice, it is to the late Professor May, the father-in-law of
Professor Naegelé, that the merit is due for having first pointed out the
advantage of exciting uterine contraction before rupturing the membranes.
(_Programma de Necessitate Partûs quandoque præmature, vel solo
Instrumentorum adjutorio promovendi._ Heidelberg, 1799.)
[104] [The student who desires to investigate this subject farther, is
referred to Dr. Churchill's Researches on Operative Midwifery, and a
copious analysis of his Essay on Premature Labour, in the _American Journ.
Med. Sc._ for Nov. 1838, p. 172, also to the Nos. of the Journal just
named, for Feb. 1838, p. 516, November 1839, p. 237, and July 1841, p.
226. Editor.]
[105] "The scissors ought to be so sharp at the points as to penetrate the
integuments and bones when pushed with moderate force, but not so keen as
to cut the operator's fingers or the vagina in introducing them."
(_Smellie_, vol. i. chap. 3. sect. 7. numb. 2.)
[106] [Dr. Churchill who has collected the statistics of this operation,
states, that in 334,258 cases of labour, the crotchet has been used in
343, or 1 in 974-1/2.
Of this number, 41,434 cases of labour occurred to British practitioners;
in which, there were 181 crotchet cases, or about 1 in 228.
Among the French, 36,169 cases of labour; of which there were 30 crotchet
cases, or 1 in 1,205-2/3.
And among the Germans, 132 crotchet cases, in 256,655 labours, or 1 in
1,944-1/3. Of 251 cases, in which the result to the mother is given, the
mortality was 52, or about 1 in 5. (_Op. Cit._) Editor.]
[107] The above arrangement is that which is given by Professor Naegelé,
in his _Lehrbuch der Geburtschülfe_.
[108] _Pratique des Accouchemens_, p. 21. "Je puis assurer n'avoir jamais
rencontré aucune position du col, ni du tronc proprement dit." (p. 19.)
[109] Merriman's Synopsis of difficult Parturition, last edition, p. 69.
The elongated form of the protruded bag of membranes is, however, by no
means a constant occurrence, as cases frequently occur where nothing of
the kind has appeared.
[110] Boer's _Naturliche Geburtshülfe_, b. iii. p. 64. A case of actual
evolution has also been described by Mr. Barlow, p. 399.
[111] Med. Chir. Trans., case by Dr. Smith, of Maidstone. See also an
interesting case by Professor Naegelé, in the British and Foreign Medical
Review, where the uterus was ruptured by sudden violence, part of the
child was delivered per vaginam, the rest by an abscess through the
abdominal parietes. No. x. April, 1838.
[112] Lassus, Pathologie Chirurgicale, tom. ii. p. 237, quoted by Dr.
M'Keever, _op. cit._ p. 27.
[113] Collins, _op. cit._ p. 277. An interesting case of rupture at the
sixth month, is recorded by Mr. Ilot, of Bromley, in the seventh volume of
the Medical Repository, and quoted by Dr. Merriman, who has also given
another at the eighth month by Mr. Glen, p. 268. See also an interesting
case in the Brit. and For. Med. Rev. for October, 1838, p. 539.
[114] [Another case is recorded by Dr. Carmichael, of Dublin. See _Amer.
Journ. Med. Sc._, May 1840, p. 236.--ED.]
[115] The late Professor Young, of Edinburg, has described a case of this
sort in his lectures: he distinctly "heard the head crack, and a large
quantity of fluid came away."
[116] Observationes Anatomicæ, 52. A similar case has been recorded by Dr.
Wrangel, in the Archiv. der Gesellschaft der Correspondirenden Aerzte zu
St. Petersburg.
When called to the case, the forceps had been already applied by a
colleague, but could not be locked, owing to the enormous tumour of the
head. A doughty swelling was felt between the blades of the forceps, of
such a size that he could only just reach the cranial bones. He made
pretty strong traction twice, when unluckily the instrument slipped off;
it seemed, however, to have brought the head so much lower, that the child
was delivered in ten minutes afterwards by the natural efforts: it was
dead. A sac filled with serous fluid, and as large as the head itself, was
attached to the occiput; it was covered by the cranial integuments, and in
ten hours afterwards, as the fluid had found its way through the open
sutures into the cranial cavity, the tumour had the appearance of a
hydrocephalus.
[117] Quoted by Dr. Lee in the Med. Gazette, Dec. 25, 1830, from the
Journ. Gén. de Méd. tom. xliii. xlv.
[118] Merriman's Synopsis, p. 216.; also Dr. J. Y. Simpson's fifth case of
fatal peritonitis, in Edin. Med. and Surg. Journ. No. cxxxvii. The patient
had suffered under four different attacks of venereal disease. Some
interesting cases have been published in the Neue Zeitschrift für
Geburtskunde, band vii. heft 1. by Dr. Bunsen of Frankfort and Dr. Kyll of
Cologne. In almost every case of great accumulation of liquor amnii, the
child was dead, hydrocephalic, or with ascites and in many the placenta
was diseased.
[119] [Dr. Churchill has given a table of the length of the umbilical cord
in 500 cases. In 127 of these, the cord was 18 inches long, in 77 cases 24
inches, and in 45 cases 20 inches long. The extremes were 12 and 54
inches. _Op. Cit._--ED.]
[120] In a case of this sort Mauriceau says, "Ce noeud étoit extrémement
serré: mais cela ne s'etoit fait seulement que dans la sortie de l'enfant;
car s'il eût été long-temps serré de la sorte dans le ventre de la mère,
l'enfant auroit certainement peri; à cause que le mouvement du sang que
lui étoit nécessaire, auroit été entièrement intercepté dans ce cordon.
J'ai encore accouché depuis ce temps la, sept autres femmes, dont les
enfans qui étoient tous vivans, avoient pareillement le cordon noüé d'un
semblable noeud qui s'étoit fait de la même manière, par l'extraordinaire
longueur de leur cordon." (_Obs._ 133.)
[121] [Dr. Zollickoffer, of Middleburg, Md., relates two cases, in each of
which there was a knot upon the cord without any injury to the children.
_American Journal, Med. Sc._ July 1841, p. 109.--ED.]
[122] Van Swieten, in his Commentaries on Boerhaave, gives a remarkable
instance of its occurring twice in the same patient, so as to destroy the
child. "I had occasion to see two instances of the birth of a dead child
in one lady of distinction, where every thing was exactly and rightly
formed; only the navel string was, towards the middle, twisted into a firm
knot, so that all communication between the mother and foetus had been
intercepted. The umbilical rope seems to have formed by chance a link,
through which the whole body of the foetus passed, and afterwards, by its
motion and weight, had drawn the knot, already formed, into such a degree
of tightness, that the umbilical vessels were entirely compressed; for
when the knot was loosened out, all that part of the navel string which
was taken into the knot was quite flattened." (Vol. xiii. § 1306.)
[123] One of the most remarkable cases of extreme pelvic deformity from
mollities ossium is described by Professor Naegelé in his Erfahrungen und
Abhandlungen. The patient was the mother of six living children when she
was attacked with the disease: the seventh, after great difficulty, was
born dead, and the eighth was delivered by the Cæsarean operation, which
proved fatal. The spine was pressed so downwards, that the third lumbar
vertebra was opposite to the superior edge of the symphysis pubis; the
distance of the left ramus of the pubes from the fourth lumbar vertebra
was only 2-1/2 lines; the transverse diameter of the inferior aperture
only 1 inch 9 lines. For the farther details of this interesting case we
may refer to our published lectures on this subject. A similar and highly
interesting case has been recorded by Mr. Cooper, and communicated by Dr.
Hunter in the Medical Observations and Inquiries, vol. v. The patient's
first three labours were rather easy; in the beginning of her fourth
pregnancy she had a violent rheumatic fever, which continued about six
weeks; from this time she never enjoyed good health and suffered
constantly from rheumatic pains over her whole body: these were followed
by laborious respiration, and gradual distortion of spine: her fourth
labour was accomplished with much difficulty. During her fifth pregnancy
the distortion continued to increase. In her sixth and seventh labours the
pelvis was found much contracted, so much so in the last as to require
perforation. In her eighth labour the pelvis then appeared to be somewhat
less than 2-1/2 inches from the symphysis of the ossa pubis to the
superior and projecting part of the os sacrum, and otherwise badly formed.
Embryotomy was again performed. She had become much more deformed and
helpless, but in three years afterwards she was again pregnant. "She now
appeared to be little more than an unwieldy lump of living flesh." The
antero-posterior diameter was now only 1-1/4 inch, becoming gradually
narrower at each side. The Cæsarean operation was performed with a fatal
result. On examination after death, the rami of the ischium were found
"little more than half an inch asunder."
[124] [A second case has been recorded by Dr. Schultzen, see _American
Jour. Med. Sc._ July 1841, p. 238.--Ed.]
[125] "Mechanical obstruction to the progress of labour, is sometimes
produced by thus fatiguing the woman with continual walking. I have known
the whole of the cellular substance lining the pelvis so much distended by
oedematous tumefaction, as to make the pelvis greatly narrowed in its
capacity, which repose for some hours has diminished, or entirely
removed." (Merriman's _Synopsis_, p. 18. last edit.)
[126] Mr. Barlow has attempted to form a synoptical table of pelvic
distortion. Thus, he says, where the antero-posterior diameter of the brim
is from 5 to 4 inches, delivery can be effected by the efforts of nature
alone; where from 4 to 3 or 2-3/4 inches, delivery may take place by the
efforts of nature, or assisted by the crotchet, or lever; from 2-3/4 to
2-1/2 inches, it requires artificial premature delivery; from 2-1/2 to
1-1/2 inches, embryulcia; and from 1-1/2 inch to the lowest possible
degree of distortion, the Cæsarean operation.
[127] For many of the above observations we are indebted to an admirable
article upon the subject by our friend, Professor Naegelé, jun., in the
_Medicenischen Annalen_, band ii. heft 2.
[128] Dr. Merriman has detailed two interesting cases, which were
terminated by the natural powers. In the first (p. 59,) the patient died
afterwards, a small laceration having taken place in the vagina; the other
appears to have arisen from an unruptured state of the hymen, which was of
unusual thickness; (see Appendix II.) The case did well.
[129] For much valuable information on this subject, as also for several
interesting cases, we gladly refer to Facts and Cases in Obstetric
Medicine, by our friend Mr. Ingleby, of Birmingham; a practical work of
great value.
[130] [The following very singular case of tumour of the pelvis is
recorded by Professor D'OUTREPONT, of Würtzburg.
A woman, twenty-six years old and well made, gave birth when twenty-five
years of age to her first child without difficulty. Towards the end of her
second pregnancy she again applied at the hospital in consequence of
experiencing pain in the pelvic region. Vaginal examination discovered a
hard and painful tumour, extending from the inner surface of the left
ischium nearly to the corresponding point on the opposite side. It was
hard, globular, even on its surface, and occupied the ascending ramus of
the ischium and the descending ramus of the pubis, and extended over the
obturator foramen. It was impossible to reach the lower segment of the
uterus, or to feel any part of the child.
The size and hardness of the tumour seemed to leave no chance of the birth
of a living child, even by the induction of premature labour. Professor
D'Outrepont, who doubted whether the tumour was fibro-cartilaginous, or a
true bony exostosis, asked the opinion of many eminent men who saw the
case. They did not express themselves with certainty as to its nature, and
the patient refused to allow an experimental incision to be made into the
tumour.
A short time before labour began, the tumour was thought to have become
slightly compressible. When labour commenced, the professor called a
consultation in which it was determined that unless a great change had
taken place in the character of the tumour, an attempt should be made to
remove it, or to cut away the bone if that should be found to be
implicated, and as a last resource, to perform the Cæsarean section.
On an examination being made, the right foot of the child was found to
present, the cord was prolapsed, and did not pulsate. The tumour, however,
was found to be so much softened that it was possible to pass three
fingers through the outlet of the pelvis. Professor D'Outrepont brought
down the foot, in doing which, he found that the hips had compressed the
tumour still more. The chief difficulty was experienced in extracting the
head by means of the forceps, which gave the patient considerable pain.
The child was still-born, but was speedily recovered. After the birth of
the child, the tumour regained its former size, so that the placenta could
not be expelled by the natural efforts, and it was necessary to introduce
the hand in order to remove it.
The patient recovered rapidly, and returned ten weeks after her delivery,
in order to have the tumour removed, which operation was performed by
Professor Textor. The growth was found to be fibro-cartilaginous, and was
connected neither with the bone nor the periosteum. It weighed 11-1/2
ounces, and was so hard that none but they who were present at the
patient's delivery, could have believed its previous softening possible.
The patient was completely cured.--ED.]
[131] A sudden drink of cold fluid will generally excite contractions of
the uterus, owing to the close sympathy which exists between it and the
stomach. A couple of ounces, at most, will be sufficient for this purpose,
if swallowed quickly; a larger quantity not only fails of its effect, by
oppressing the stomach, but, by filling it with fluid, renders almost
inert any stimuli or medicines which may afterwards be required.
[132] "Cold injections," says Dr. Young, "should be thrown into the
uterus, and repeated ten or twelve times; as on this the success depends."
(_MS. Lectures._)
[133] Essay on Inversion of the Uterus. Dublin Journal for September and
November, 1837, quoted by Dr. Churchill on Diseases of Females, p. 317.
[134] Midwifery Hospital Reports. Med. Gazette, May 31, 1834; also Aug.
26, 1837.
[135] "I have reason to believe that a placenta which is entire and
uninjured, which is enclosed in the uterus, adherent to it, and shut out
from access of air, _never becomes putrid_." (Matthias Saxtorph, _Gesamm.
Schriften_.)
[136] [An interesting memoir on retained placenta, by Dr. Edward Warren,
of Boston, will be found in the _American Journal of Med. Sc._ May, 1840,
p. 71.--ED.]
[137] Dr. Churchill observes, "I have found, in several cases of prolapse,
that the placenta was situated low down on the side of the uterus, and in
some few others that the funis was inserted into the lower edge of the
placenta." (_Edin. Med. and Surg. Journal_, Oct., 1838.)
[138] [Dr. Churchill in his _Researches on Operative Midwifery_,
subsequently published, has collected the results of 92,017 deliveries, in
which there was prolapse of the cord, in 333 cases, or 1 in every
276-2/3.--ED.]
[139] [A figure of this instrument is given in Dewees' Midwifery, Pl.
XVIII. and the method of using it fully described.--ED.]
[140] In the edition which has been translated into English, A. D. 1612,
it is the _twelfth_ chapter.
[141] We subjoin the passages to which we have referred in the three above
mentioned cases:--
Case 115. "I cannot implicitly accede to the opinion of roost writers in
midwifery, which is, that the placenta always adheres to the fundus uteri;
for in this, as well as many former instances, I have good reason to
believe that it sometimes adheres to or near the os internum, and that the
opening of it occasions a separation, and consequently a flooding."
Case 116. "The first thing I met with was the placenta, which I found
closely adhering round the os internum of the uterus, which, among other
things, is a proof that the placenta is not always fixed to the bottom of
the uterus, according to the opinion of some writers in midwifery. Its
adhering to the os internum was, in my opinion, the occasion of the
flooding; for as the os internum was gradually dilated, the placenta at
the same time was separated, from whence proceeded the effusion of blood."
Case 224. "It is generally believed that the ovum, after its impregnation
and separation from the ovarium, and its passing through the tuba
Fallopiana, always adheres, and is fixed, after some time, to the fundus
uteri; in this case the placenta adhered, and was fixed close to and round
about the cervix uteri, as I have found it in many other cases, so that
upon a dilatation of the os uteri a separation has always followed, and
hence a flooding naturally ensues."
[142] The second edition of Roederer's admirable _Elementa Artis
Obstetriciæ_, which was published by his distinguished successor,
Wrisberg, in 1766, three years after his death, is that which is chiefly
known, although it never had an extensive circulation in this country. The
means of communication with the Continent at that time were very different
to what they are at present; and although none can regret more than
ourselves that Roederer's work should have passed unnoticed in Dr. Rigby's
_Essay on Uterine Hæmorrhage_, still we feel assured that the liberal
portion of the medical world, whether in this or other countries, will not
attribute this omission to a disingenuous suppression of his name, but
rather to the more probable circumstances that, residing in a provincial
town, and actively engaged in the arduous duties of an extensive country
practice, Dr. Rigby had not enjoyed an opportunity of consulting the work;
at any rate, we have good reasons to know that he never possessed it.
[143] Not 1776, as stated by Dr. R. Lee.
[144] Dr. Merriman has also recorded three cases of this kind, one of
which occurred to himself; in this case "the placenta was expelled many
hours before the child was born;" the mother died from puerperal fever.
[145] [A very interesting account of puerperal peritonitis, as it
prevailed in the Pennsylvania Hospital in 1833, is given by Professor H.
L. Hodge, in the _American Journal Med. Sc._, for August, 1833, p. 325, et
seq.--ED.]
[146] This condition of parts bore the closest analogy to the state of the
cellular membrane, so constantly observed in fatal cases of phlegmonoid
erysipelas, or diffuse cellular inflammation.
[147] [The student may consult, with advantage, Dr. Dewees's chapter on
Phlegmasia Dolens, in his "Treatise on the Diseases of Females," also the
observations of Dr. Mann, in the "Massachusetts Medical Communications,"
vol. ii., and the interesting paper, by Professor Walter Channing, in the
same work, vol. v. p. 46.--EDITOR.]
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language that has yet appeared. We do not know any volume which
contains so much information in a small compass. The Bibliographical
notices, though so short, are very important and useful; and
altogether we can recommend to every medical man to have this work by
him, as the cheapest and best dictionary of reference he can
have."--_London Medical and Surgical Journal._
"So far as we have been able to examine this Dictionary, it is
exceedingly thorough and correct, not only in matters purely medical,
but in whatever can fairly be arranged in the various branches of
science, collateral or contributary to Medicine and
Surgery."--_Medical Magazine._
"So well known are the merits of this valuable work, that, in noticing
a second edition of it, it will suffice to extract the remark of the
author in the preface, 'that it will be found to contain many hundred
terms more than the first, and to have experienced numerous additions
and modifications.' It has been got up by the publishers in very
handsome style, and must command, as it deserves, an extended
circulation."--_Medical Examiner._
"It is wholly unnecessary, we apprehend, to enter into a long or
formal statement of the fact, that Dr. Dunglison's Dictionary, from
the first day of its appearance, has been regarded with peculiar
favour. And we have now a revised edition, constructed under the
immediate eye of the author, who is most favourably circumstanced for
adding to the previous edition whatever could give it additional
claims on the score of accuracy. Here are eight hundred and twenty-one
pages, large octavo, in double colums, distinct type, of which no one
ought to complain. Finally, although most of our readers may be owners
of the first edition, we cordially and conscientiously recommend to
all future purchasers to procure this in preference to any medical
lexicon extant. Its true and sterling value as a key to medical
science, and its moderate price, are so many common-sense
recommendations which should not be forgotten."--_Boston Medical and
Surgical Journal._
A NEW AND VALUABLE WORK FOR PHYSICIANS, APOTHECARIES, AND STUDENTS.
NEW REMEDIES, _The Method of Preparing & Administering them_; THEIR
EFFECTS UPON THE HEALTHY AND DISEASED ECONOMY, &c. &c.
BY ROBLEY DUNGLISON, M. D.
_Professor of the Institutes of Medicine and Materia Medica in Jefferson
Medical College of Philadelphia; Attending Physician to the Philadelphia
Hospital, &c._
IN ONE VOLUME, OCTAVO.
"The value of this book is hardly to be estimated; to be without it,
would be very much like obstinacy, and amount to the same thing as
saying, like the Austrians in regard to their government, nothing can
be improved, for we already live in a state of perfection. Dr.
Dunglison, the author, has done an essential service to all classes of
practitioners. It is creditable to the industry and wise
discrimination of the author, and quite necessary to the libraries of
those who feel the necessity of keeping pace with the improvements and
discoveries in the broad but imperfectly exploded domain of
medicine."--_Boston Medical and Surgical Journal._
_A Third Edition, Improved and Modified, of_ DUNGLISON'S HUMAN PHYSIOLOGY:
_Illustrated With Numerous Engravings_.
IN TWO VOLUMES, OCTAVO.
"We are happy to believe that the rapid sale of the last edition of
this valuable work may be regarded as an indication of the extending
taste for sound physiological knowledge in the American schools: and
what we then said of its merits, will show that we regarded it as
deserving the reception it has experienced. Dr. Dunglison has, we are
glad to perceive, anticipated the recommendation which we gave in
regard to the addition of references, and has thereby not only added
very considerably to the value of his work, but has shown an extent of
reading which, we confess, we were not prepared by his former edition
to expect. He has also availed himself of the additional materials
supplied by the works that have been published in the interval,
especially those of Müller and Burdach. So that as a collection of
details on human physiology alone, we do not think that it is
surpassed by any work in our language: and we can recommend it to
students in this country (England) as containing much with which they
will not be likely to meet elsewhere."--_British and Foreign Medical
Review._
"This work exhibits another admirable specimen of American industry
and talent, and contains an account of every discovery in Europe up to
the period of a few months prior to its publication. Many of the
author's views are original and important."--_Dublin Journal of
Medical Sciences._
GENERAL THERAPEUTICS; OR, PRINCIPLES OF MEDICAL PRACTICE.
_With Tables of the Chief Remedial Agents and their Preparations, and of
the Different Poisons and their Antidotes._
BY ROBERT DUNGLISON, M. D., &c., &c.
One Volume, large 8vo.
"There being at, present before the public several American works on
Therapeutics, written by physicians and teachers of distinction, it
might be deemed unjust in us, and would certainly be invidious, to
pronounce any of them superior to the others. We shall not, therefore,
do so. If there be, however, in the English language, any work of the
kind more valuable than that we have been examining, its title is
unknown to us.
"We hope to be able to give such an account of the work as will
strengthen the desire and determination of our readers to seek for a
farther acquaintance with it, by a candid perusal of the volume
itself. And, in so doing, we offer them an assurance that they will be
amply rewarded for their time and labour."--_Transylvania Journal_,
Vol. IX, No. 3.
THE MEDICAL STUDENT; or, Aids to the Study of Medicine. Including a
Glossary of the Terms of the Science, and of the Mode of Prescribing;
Bibliographical Notices of Medical Works; the Regulations of the Different
Medical Colleges of the Union, &c. By Robley Dunglison, M. D., &c., &c. In
one volume, 8vo.
ELEMENTS OF HYGIENE; on the Influence of Atmosphere and Locality; Change
of Air and Climate, Seasons, Food, Clothing, Bathing, Sleep, Corporeal and
Intellectual Pursuits, &c., on Human Health, Constituting Elements of
Hygiene. By Robley Dunglison, M. D. &c., &c. In 1 vol. 8vo.
MEDICAL ESSAYS.
THE CYCLOPEDIA OF PRACTICAL MEDICINE AND SURGERY,
_Or Essays on ASTHMA, APHTHÆ, ASPHYXIA, APOPLEXY, ARSENIC, ATROPA, AIR,
ABORTION, ANGINA-PECTORIS, and other Subjects Embraced in the Articles
from A to Azote, prepared for the Cyclopedia of Practical Medicine by_
Dr. Chapman,
Dr. Jackson,
Dr. Horner,
Dr. Hodge,
Dr. Wood,
Dr. Dewees,
Dr. Hays,
Dr. Dunglison,
Dr. Mitchell,
Dr. Bache,
Dr. Coates,
Dr. Condie,
Dr. Emerson,
Dr. Geddings,
Dr. Griffith,
Dr. Harris,
Dr. Warren,
Dr. Patterson,
Each article is complete within itself, and embraces the practical
experience of its author, and as they are only to be had in this
collection will be found of great value to the profession.
[Symbol: Asterism] The two volumes are now offered at a price so low,
as to place them within the reach of every practitioner and student.
GIBSON'S SURGERY.
A NEW EDITION OF GIBSON'S SURGERY.
THE INSTITUTES AND PRACTICE OF SURGERY; being the Outlines of a Course of
Lectures. By William Gibson, M. D., Professor of Surgery in the University
of Pennsylvania, &c. &c. Fifth edition, greatly enlarged. In 2 vols. 8vo.
With thirty plates, several of which are coloured.
"The author has endeavoured to make this edition as complete as
possible, by adapting it to the present condition of surgery, and to
supply the deficiencies of former editions by adding chapters and
sections on subjects not hitherto treated of. And, moreover, the
arrangement of the work has been altered by transposing parts of the
second volume to the first, and by changing entirely the order of the
subject in the second volume. This has been done for the purpose of
making the surgical course in the university correspond with the
anatomical lectures, so that the account of surgical diseases may
follow immediately the anatomy of the parts."
DEWEES'S WORKS.
A PRACTICE OF PHYSIC, comprising most of the diseases not treated of in
Diseases of Females and Diseases of Children. By W. P. Dewees, M. D.,
formerly adjunct professor in the University of Pennsylvania. In one
volume, octavo.
A COMPENDIOUS SYSTEM OF MIDWIFERY.
By DR. DEWEES.
Chiefly designed to facilitate the Inquiries of those who may be pursuing
this branch of Study. Illustrated by occasional cases and with many
plates. The ninth edition, with additions and improvements. In one vol.
8vo.
DEWEES ON THE DISEASES OF FEMALES.
The seventh edition. Revised and Corrected. With additions, and Numerous
plates. In one vol. 8vo.
DEWEES ON THE PHYSICAL AND MEDICAL TREATMENT OF CHILDREN.
With Corrections and Improvements. The seventh ed. In one volume, 8vo.
The objects of this work are, 1st, to teach those who have the charge
of children, either as parent or guardian, the most approved methods
of securing and improving their physical powers. This is attempted by
pointing out the duties which the parent or the guardian owes for this
purpose, to this interesting but helpless class of beings, and the
manner by which their duties shall be fulfilled. And 2d, to render
available a long experience to these objects of our affection when
they become diseased. In attempting this, the author has avoided as
much as possible, "technicality;" and has given, if he does not
flatter himself too much, to each disease of which he treats, its
appropriate and designating characters, with a fidelity that will
prevent any two being confounded together, with the best mode of
treating them, that either his own experience or that of others has
suggested.
HORNER'S SPECIAL ANATOMY.
A Treatise on Special and General Anatomy. By W. E. Horner, M. D.,
Professor of Anatomy in the University of Pennsylvania, &c. &c. Fifth
edition, Revised, and much improved. In two volumes, 8vo.
ELLIS' MEDICAL FORMULARY.
The Medical Formulary, being a collection of prescriptions derived from
the writings and practice of many of the most eminent Physicians in
America and Europe. To which is added an appendix, containing the usual
Dietetic preparations and Antidotes for Poisons, the whole accompanied
with a few brief Pharmacuetic and Medical observations. By Benjamin Ellis,
M. D., Fifth edition, with additions. In one vol.
Broussais on Inflammation, 2 vols. 8vo.
Broussais' Pathology, 1 vol. 8vo.
Colles' Surgical Anatomy, 1 vol. 8vo.
Costers' Physiological Practice, 1 vol. 8vo.
Greys' Chemistry applied to the Arts, 2 vols. with numerous plates.
ELEMENTS OF PHYSICS, OR NATURAL PHILOSOPHY, GENERAL AND MEDICAL, explained
independently of TECHNICAL MATHEMATICS, and containing New Disquisitions
and Practical Suggestions. By NEIL ARNOTT, M. D. In two volumes, octavo.
"Dr. Arnott's work has done for Physics as much as Locke's Essays did
for the science of mind."--_London University Magazine._
"We may venture to predict that it will not be surpassed."--_Times._
"Dr. A. has not done less for Physics than Blackstone did for the
Law."--_Morning Herald._
"Dr. A. has made Natural Philosophy as attractive as Buffon made
Natural History."--_French Critic._
"A work of the highest class among the productions of
mind."--_Courier._
ROGET'S PHYSIOLOGY AND PHRENOLOGY.
OUTLINES OF PHYSIOLOGY; WITH AN APPENDIX ON PHRENOLOGY;
BY P. M. ROGET., M. D.
Professor of Physiology in the Royal Institute of Great Britain, &c. &c.
FIRST AMERICAN EDITION, Revised, with numerous notes, In one volume, 8vo.
From the American Preface.--"Of the Author's qualifications as a
physiological writer it is scarcely requisite to speak. The fact of
his having been selected to compose the Bridgewater Treatise on Animal
and Vegetable Physiology, is sufficient evidence of the reputation
which he then enjoyed; and the mode in which he executed the task
amply evinces that his reputation rested on a solid basis.
"The present volume contains a concise, well-written epitome of the
present state of Physiology--human and comparative--not, as a matter
to be expected, the copious details and developments to be met with in
the larger treatises on the subject; but enough to serve as an
accompaniment and guide to the physiological student.
"The attention of the American Editor has been directed to the
revision and correction of the text; to the supplying, in the form of
notes, of omissions; to the rectification of some of the points that
appeared to him erroneous or doubtful, and to the furnishing of
references to works in which the physiological inquirer might meet
with more ample information.
"In Phrenology, the Author is a well-known unbeliever, and his
published objections to the doctrine have been regarded as too cogent
to be permitted to pass unheeded. It will be seen on farther
examination in the interval of many years, which has elapsed since the
publication of the sixth edition of the Encyclopædia, has not induced
him to modify his sentiments on this head. On the contrary, he appears
to be as satisfied at this time, of the fallacy of the positions of
the Phrenologist, as he was at any former period."
[Symbol: Pointing hand] This work will be introduced into many of the
Medical Colleges of the union as a Text Book, it being a cheap volume,
and well fitted as an introduction to the larger works on Physiology.
COATES POPULAR MEDICINE:
POPULAR MEDICINE; OR, FAMILY ADVISER.
Consisting of outlines of Anatomy, Physiology, and Hygiene, with such
Hints on the Practice of Physic, Surgery, and the Diseases of Women and
Children, as may prove useful in families when regular Physicians cannot
be procured: Being a Companion and Guide for intelligent Principals of
Manufactories, Plantations, and Boarding Schools: Heads of Families,
Masters of Vessels, Missionaries, or Travellers, and a useful Sketch for
Young Men about commencing the Study of Medicine.
BY REYNELL COATES, M. D.
Fellow of the College of Physicians of Philadelphia--Honorary Member of
the Philadelphia Medical Society--Correspondent of the Lyceum of Natural
History of New York--Member of the Academy of Natural Sciences of
Philadelphia--Formerly Resident Surgeon of the Pennsylvania Hospital, &c.
Assisted by several Medical friends. In One Volume.
"It is with great satisfaction that we announce this truly valuable
compilation, as the most complete and interesting treatise on Popular
Medicine ever presented to the public. Simple and unambitious in its
language, free from the technicalities, and embracing the most
important facts on Anatomy, Physiology and Hygiene, or the art of
preserving health; and the treatment of those affections which require
immediate attention, or are of an acute character, this should be in
the hands of every one, more particularly of those who, by their
situations are prevented from resorting to the advice of a physician,
nor would the careful perusal of its pages fail to profit the
inhabitants of our cities, by giving them a more accurate knowledge of
the structure of the human frame, and the laws that govern its various
functions; whose perfect integrity is absolutely essential to health,
and even to existence; the various systems of medical charlatanry,
daily imagined to take advantage of the credulity and ignorance of
mankind, would be rendered far less prejudicial to the community than
they now are. We would particularly direct attention to the Chapter on
Hygiene, a science in itself of the utmost importance, and ably
treated in the small space allowed to it in this volume."--_New York
American._
DR. CLARK ON CONSUMPTION.
A Treatise on Pulmonary Consumption, comprehending an inquiry into the
Nature, Causes, Prevention, and Treatment of Tuberculous and Scrofulous
Diseases in General. By James Clark, M. D., F. R. S.
"As a text-book and guide to the inexperienced practitioner we know
none equal to it in general soundness and practical utility--to the
general as well as to the professional reader, the work will prove of
the deepest interest, and its perusal of unequivocal
advantage."--_British and Foreign Medical Review._
"The work of Dr. Clark may be regarded as the most complete and
instructive Treatise on Consumption in the English
Language."--_Edinburgh Medical and Surgical Journal._
CHITTY'S JURISPRUDENCE.
A Practical Treatise on Medical Jurisprudence, with so much of Anatomy,
Physiology, Pathology, and the Practice of Medicine and Surgery, as are
essential to be known by Members of the Bar and Private Gentlemen; and all
the laws relating to Medical Practitioners; with explanatory plates. By J.
Chitty, Esq. Second American edition: with Notes and Additions, adapted to
American works and Judicial Decisions. 8vo.
A TREATISE ON THE PRACTICE OF MEDICINE, or a Systematic Digest of the
Principles of General and Special Pathology and Theraputics. By E.
Geddings, (now preparing.)
SMITH ON FEVER.
A Treatise on Fever. By Southwood Smith, M. D., Physician to the London
Fever Hospital. Fourth American edition. In 1 volume 8vo.
FITCH'S DENTAL SURGERY.
A Treatise on Dental Surgery. Second edition, revised, corrected, and
improved, with new plates. By S. S. Fitch, M. D. 1 vol. 8vo.
ABERCROMBIE ON THE BRAIN.
Pathological and Practical Researches on Diseases of the Brain and Spinal
Cord. Second American, from the third Edinburgh edition, enlarged. By John
Abercrombie, M. D. In 1 volume 8vo.
ABERCROMBIE ON STOMACH.
Pathological and Practical Researches on Diseases of the Stomach, the
Intestinal Canal, the Liver, and other Viscera of the Abdomen. By John
Abercrombie M. D., third American from the second London edition enlarged.
In 1 vol. 8vo.
EWELL'S MEDICAL COMPANION.
The Medical Companion or Family Physician: treating of the Diseases of the
United States, with their symptoms, causes, cure, and means of prevention.
BERTIEN ON THE HEART.
A Treatise on Diseases of the Heart and Great Vessels. By J. R. Bertien.
Edited by G. Bouillaud. Translated from the French. 8vo.
BOISSEAU ON FEVER.
Physiological Pyretology; or a Treatise on Fevers, according to the
Principles of the New Medical Doctrine. By F. G. Boisseau, Doctor in
Medicine of the Faculty of Paris, &c. &c. From the fourth French edition.
Translated by J. R. Knox, M. D. 1 vol. 8vo.
HUTIN'S MANUAL.
Manual of the Physiology of Man; or a concise Description of the Phenomena
of his Organization. By P. Hutin. Translated from the French, with notes,
by J. Togno. In 12mo.
BELL ON THE TEETH.
The Anatomy, Physiology, and Diseases of the Teeth. By Thomas Bell, F. R.
S., F. L. S. &c., third American edition. In 1 vol. 8vo. With numerous
plates.
WILLIAMS ON THE LUNGS.
A Rational Exposition of the Physical Signs of Diseases of the Lungs and
Pleura; Illustrating their Pathology and facilitating their Diagnosis. By
Charles J. Williams, M. D. In 8vo. with plates.
THE BRIDGE WATER TREATISES, COMPLETE IN SEVEN VOLUMES, OCTAVO. Embracing.
I. The Adaptation of External Nature to the Moral and Intellectual
Constitution of Man. By the Rev. Thomas Chalmers.
II. The Adaptation of External Nature to the Physical Condition of Man. By
John Kidd, M. D., F. R. S.
III. Astronomy and General Physics, Considered with References to Natural
Theology. By the Rev. Wm. Whewell.
IV. The Hand: Its Mechanism and Vital Endowments as Evincing Design. By
Sir Charles Bell, K. H., F. R. S. With numerous wood cuts.
V. Chemistry, Meteorology, and the Function of Digestion. By Wm. Prout, M.
D., F. R. S.
VI. The History, Habits and Instincts of Animals. By the Rev. Wm. Kirby,
M. A., F. R. S. Illustrated by numerous Engravings on Copper.
VII. Anatomy and Vegetable Physiology Considered with Reference to Natural
Theology. By Peter Mark Roget, M. D. Illustrated with nearly Five Hundred
Wood Cuts.
VIII. Geology and Mineralogy, Considered with Reference to Natural
Theology. By the Rev. Wm. Buckland, D. D. with numerous engravings on
copper, and a large coloured map.
[Symbol: Asterism] The work of Buckland, Kirby and Rojet may be had
separate.