Chapter 24

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 aisément.) 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. _Cæsarian 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 Cæsarian 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 Cæsarian 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 Cæsarian 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 hæmorrhage 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 hæmorrhage, 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 Hæmorrhage._--In the Bulletin Universel for Jan. 1826, the following case is detailed from the Gazette de Santé, 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 hæmorrhage 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 hæmorrhage 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 hæmorrhagic 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 Générales 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.

Mr. D'ARCET praises very highly the effects of these lozenges in disordered digestion, and in preventing its occurrence, as well from experiments made on his own person, as from observations on others. He believes their operation to be purely chemical, consisting in the saturation of the morbid acid of the stomach, and, therefore, not likely to be lessened by habit. Their effects are much more prompt than magnesia, either pure or in the state of carbonate.

In the phosphatic diathesis, where the urine is disposed to be alkaline, it would seem that these lozenges would do harm. But, perhaps, we have this security against their use in these cases, that the stomach would not at the same time be troubled with acidity. _Annales de Chimie et de Physique, Jan._ 1826.

69. _Presence of Mercury in Samples of medicinal Prussic Acid._--Mr. REGIMBEAU, apothecary at Montpellier, has detected this impurity in some prussic acid, prepared in Paris. Its presence was first suspected, from a portion of the acid, accidentally dropped, leaving a white stain on the copper dish of a balance. It is probable, that the impure acid, spoken of, had been made by passing sulphuretted hydrogen through a solution of cyanide of mercury, according to VANQUELIN'S process; and that an insufficiency of the decomposing gas had been employed.