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Fig.14. Fig.15

Figs. 9 and 10.-Gruithuisen's instruments for perforating and

crushing calculi, (1812-1813.) Fig. 9, the canula, perforator,

and wire loop for fixing the calculus. Fig. 10, the canula, Fics. 6, 7, 8.-Sanctorius' Instruments (1626) for the perforation and containing a toothed perforator.

extraction of stone from the urethra and bladder. Fig 6, the perfo- Fig. 11.-Gruithuisen's forceps for crushing the calculus after
rator closed. Fig. 7, the barbed stilet. Fig. 8, the forceps for ex. it was perforated.
tracting from the bladder the calculus when perforated.

Fig. 12. - His hook for crushing fragments against the end of

the canula. In 1671, Ciucci, an Italian surgeon, speaks of a “ tenacula tricuspis," (as the most effectual mode of curing stone,) with

a barren speculation, perhaps for centuries, had not the genius which the calculus was seized and broken up into fragments.

of the French surgeon been directed to the same point, while In 1791,

Thomassini established the possibility of breaking his perseverance conducted him through a host of difficulties up small friable calculi in the bladder; and it is asserted that to a triumphant application of the principle.. a Spanish surgeon named Rodriguez performed this operation The first idea of endeavouring to cure stone in the bladder, at Malaga in the year 1800. The well-known facts of Colonel without having recourse to the knife, seems to have presented Martin and the Citeaux monk, I need merely allude to; the itself to M. Civiale in the year 1817. He was then a medical former delivered himself from calculus by filing the stone, the student of very limited means, and employed, I believe, as an latter by percussion. Sir Philip. Crampton mentions a fact long anterior to either of them: the history of an Irish gentleman, in 1559, who was cured of stone by some instruments

Fig.13. passed into the bladder, and employed to break up the

Fig.16. calculus.

These, gentlemen, are all isolated facts. It is impossible to determine from them the precise nature of the operation employed, or whether it was ever converted into a system. Besides, they were completely forgotten or unknown.

In 1813, M. Gruithuisen, a Bavarian surgeon, published two memoirs on lithotrity in the Saltzburg Medico-Chirurgical Gazette. These were remarkable productions in every respect; and if M. Gruithuisen did not discover lithotrity, we must at least acknowledge that he was very near doing so. look at the drawings of his instruments, you will find, 1stly, a straight canula, intended to pass into the bladder, and serye as a conductor for, 2ndly, a perforator, which was either lanceshaped or dentated; 3rdly, a wire for seizing and fixing the calculus; 4thly, a handle rapidly moved by a bow drill; 5thly, a branched forceps and a hook for the purpose of crushing the fragments of stone when divided by the perforator.

Here, then, for the first time in the history of lithotrity, we find a whole and complete system, embracing all the essential parts of the operation, such as it is performed at the present day; and we may conclude that if M. Gruithuisen had possessed but a tithe of the perseverance displayed by M, Civiale, the honour of having discovered lithotrity would have belonged to Germany, not to France. It should, however, be observed that the operation of lithotrity could never have been performed with the apparatus invented by Gruithuisen. The wire could never seize calculus, and the forceps, from its shape and construction, could have little, if any, crushing power. It does not appear that the instruments were ever tried on the dead body,-certainly not on the living; the project received little attention, and was soon forgotten, like Figs. 13, 14, 15, 16. - M. Civiale's original instruments, as those which had preceded it. Besides, it does not appear that designed in his memoir of 1818. Fig. 13, a section of the sixM, Gruithuisen's proposal exercised any influence on the bladed forceps for seizing the calculus; the lance-jointed stilet

is seen in the middle. Fig. 14, the instrument when closed, subsequent discoveries of Civiale, to whom it was entirely

Fig. 15, a dentated perforator, Fig. 16, a lance-shaped perunknown, and it is quite obvious that it would have remained

forator,

If you

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MR. COULSON ON LITHOTOMY AND LITHOTRITY.

3

externe under Dupuytren. Having made a few experiments, Had M. Civiale contented himself with the first project
and constructed some models in wood, he made an application it is evident that he would now be entitled to even
to the French minister, in July, 1818, for pecuniary aid towards less merit than Gruithuisen; but he was supported by
constructing his instruments; and at the same time forwarded the firm conviction that the principle of lithotrity was a
a short memoir, with drawings, entitled, “ Some Details of a valuable one, and being endowed with great perseverance he
Lithotriptic.". The drawings of three different instruments continued his researches with the very limited means at his
were attached to the memoir; but I need only notice one of command. In 1819, he reduced the six branches of the
them, as the other two were of little or no value. The instru: forceps to four, and in 1820, to three; in the same year, also,
ment to which I now allude consisted of two hollow metallic he added a bow drill, and made several other improvements
tubes, (see drawing>) gliding on one another, the internal one of minor importance. With these improved instruments
supported at its vesical extremity; six elastic steel branches, numerous experiments were publicly made during the early
slightly curved at the end, and solidly fixed to the inner tube part of the year 1822, at the Hospital of La Pitié, and in the
In the original drawing, these branches are shown as being dissecting rooms of the Faculty. Many young men, who
joined to the tube by hinges; but this was an error of the subsequently distinguished themselves, were present at all
artist, for the text distinctly states that they opened by these experiments; and it is not surely going too far to imagine
their elasticity; nor is any allusion whatever made to hinges that M. Amussat and M. Leroy had become acquainted with
The lithotriteur was a long steel rod, either lance-shaped or their object, if not with the means employed to attain it.
dentated-in fact, exactly like those of Gruithuisen-fixed in We thus find M. Civiale engaged since the year 1818, in
a handle, which, it would appear, was to have been worked successively improving his original instruments, and in making
with the fingers alone. There was also a strong button-screw experiments with them on the dead body.
at the external end of the instrument, to control the move- In the announcement of the principle, he was closely fol-
ments of the tubes on each other; but, as you perceive, neither lowed by Mr. Elderton, who published, in the April number of
the screw nor handle are depicted in the original drawing. the Edinburgh Medical and Surgical Journal, 1819, a proposal

The Minister of the Interior sent, as is the custom, m. for attacking calculi with a curved, two-branched instrument
Civiale's memoir to the Faculty of Medicine, who appointed and a perforator. The invention of Mr. Elderton was con-
Barons Percy and Chaussier to report on it; but these gentle sidered at the time a mere speculation, and even passed over
men took no notice whatever of the poor student's invention. without attracting any attention whatever.
His memoir remained forgotten in the archives of the Thus, gentlemen, the idea of getting rid of urinary
Faculty.

calculi by mechanical means, and without operation, pre-
sented itself in the early part of the present century, and

about the same time, to a German, a French, and an English Fig.17.

surgeon: to Gruithuisen in 1813, to Civiale in 1818, to Elderton

in 1819. For two out of the three, the idea remained unproB

ductive; the French surgeon had the merit of converting the theory into a practice. We left him in the early part of 1822, experimenting at the Ecole Pratique, attacking the hardest stones, and breaking up those as large as a small hen's egg, after five or six attempts.

Such was the history of lithotrity when M. Amussat, in April, 1822, described in a few lines an instrument which he had invented for crushing stone. This was a strong, twobladed forceps, acting laterally, concealed in a canula, and worked by a lever.

He was soon followed by M. Leroy, now better known as M. Leroy d'Etoilles. In June 1822, M. Leroy produced his

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F16. 17.--Mr. Elderton's instrument for crushing calculi, (1819).

That part which forms the curve, (a, b, fig. A) consists of two blades, (c, c, fig. B), placed laterally to each other, and which, when in contact, present a solid, round form, (c, fig. A) about the size of a large bougie. At that extremity of the curve answering to the point of the catheter (a,) the blades are connected by a joint; one blade being receired within the other, and presenting this united and uniform smooth point. At an equal distance (c, fig. A), between the commencement of the curve (6.) and its extremity (a), a second joint connects the other half (c, 6,) of the same side. This structure is common to both tbe right and left blade. At the commencement of the curve (b), there is another joint (d.) uniting the twoblades, which are bere fixed to a hollow metallic tube, made to slide readily within an outer canula, (b, g, fig, A). A small steel spring, US, fig. B), placed within the blades, at their extreme point, expands them, and they then present an opening of an ovate shape, (a, e, b, c, fig. A), The blades may be regularly and firmly closed, by simply drawing the inner tube within the outer one, while by pushing down the second tube, the blades may be expanded as before. When thus expanded, they constitute a pair of forceps (C, c, fig. B), well adapted, from their shape, capacity, and strength with which the blades may be closed, to grasp, and hold firmly, a moderately-sized calculus.

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Fig. 18.-M. Amussat's crushing forceps, (April, 1892). Figs

19, 20, 21, 22, M. Leroy d'Etoille's perforator, (June, 1822). Fig. 19, the vesical end, showing the watch-springs expanded. Fig. 20, the dentated perforator. Fig. 21. The handle to work the perforator. Fig. 22. The external extremity, showing the springs fixed by screws.

4

| DR. POWER ON THE PHYSIOLOGY, PATHOLOGY, AND PRACTICE OF MIDWIFERY.

instrument. An outer canula of silver enclosed an inner removed in four sittings. The third patient was cured with one, which latter again enclosed four long watch-springs. equal expedition on the 4th of March. Such brilliant and These were passed up along the inner canula, and formed unexpected success attracted immediate attention. On the beyond its vesical extremity a kind of net, in which it was 22nd of March, the reporters, having the original documents proposed to fix the calculus. Several kinds of perforators of 1818 in their possession, and examined the various modifiwere employed, and the handle of the perforator was turned cations of M. Civiale, together with the proofs which he by a bow drill. At the distal extremity, the springs which offered, sent in a report, which establishes M. Civiale's right, represent the blades of M. Civiale's forceps were fixed each not only to the discovery of the principle, but of the means by by a screw.

which it has been carried into practice. Envious men and A commission was appointed by the Academy of Medicine, rivals have endeavoured from time to time to attack the in July, 1822, to examine these instruments. "M. Amussat's validity of this report; but if two of the most distinguished broke; that of M. Leroy seems to have worked better, although surgeons in France, totally disinterested, and having all the it is evident, from its construction, that it could never hold a documents &c. at their command, arrived at a certain conclupermanent place amongst lithotriptic apparatus; indeed, M. sion, I cannot see why others, deprived of the means of Leroy abandoned it at once, and in April, 1823, he produced judging, should presume to overthrow it. & much better instrument, a drawing of which I show you. M. Civiale, then, is to be regarded as the discoverer of It is, as you see, an imitation of Alphonso Ferri's ball. lithotrity. I shall insist no further on this point, nor on the extractor. The forceps blades are exactly the same; the different modifications which his instruments have undergone; tube is merely hollowed, instead of being solid, to receive the for although lithotrity as a system was originally established perforator which M. Leroy added.

with straight instruments, and on the principle of perforation,

the system now almost universally adopted rests on curved Fig. 25.

instruments and the principle of crushing. Fig. 23.

(To be continued.)

Fig. 24.

ON SOME OF THE MORE IMPORTANT POINTS

IN THE PHYSIOLOGY, PATHOLOGY, AND
PRACTICE OF MIDWIFERY.

BY J. POWER, M.D., &c.

Introductory observations. In the earlier part of the present century the state of obstetrical science exhibited à most imperfect aspect, particularly as related to its physiological principles. It is true that the writings of Denman and some few other authors, assisted by the anatomical investigations of Dr. Hunter respecting the gravid uterus, began to lead to a better intelligence of the nature of uterine action, and may be considered as the harbingers of more correct and rational views; but that no positive and well-established system at the time resulted, may be inferred from the assertion of Dr. Denman,- that “no pain in labour is without its use, or ineffective in advancing its progress.” If this were the case, one of the more favourite principles of modern practice would be founded in error-namely, to deprive labour of its pain by anæsthetic means.

The first decided attempts to obviate pain in labour were made nearly contemporaneously-by an American practitioner, Dr. Dewees, who recommended bleeding almost ad deliquium; by the late Dr. Sparks, of Ipswich, who resorted to the administration of opium in very large doses; and by the author of the present paper, who, in the year 1819, published a treatise on midwifery, in which he maintained that the pains of labour might be materially lessened, and its duration

shortened, particularly by the use of friction. This work, Figs. 23, 24, 25.-M. Leroy's improved instruments, (April, 1823.) however, by no means confined itself to the above practice, Fig. 23, the forceps. Fig. 24, the instrument closed. Fig. 25, but inculcated novel views of the nature of healthy and the handle for holding the drill, mounted with a pulley for a

deranged uterine action, from which the present doctrine of the

reflex action, as applicable to parturition, has resulted, and The appearance of this latter instrument, and the claims with which (mutato nomine) they virtually correspond. which M. Leroy set up on it, drew M. Civiale from the silence The above work, although honoured with some eulogia at which he had hitherto observed; for it is necessary to remark, the time of its publication, and confessedly received as a boon that up to May, 1823, he had not published a single line on by numerous practitioners, has remained comparatively unlithotrity. To the short work on “ Retention of Urine, known, and almost entirely unnoticed by subsequent writers Urinary Calculi, and the possibility of destroying Calculi in on midwifery. Its author is now in an advanced period of life; the Bladder without Operation,” he appended the original and as he believes the work to be out of print, he deems it memoir of 1818, with the original drawings; and also indi. an act of justice to himself, if not of professional utility, to cated, in a very summary manner, the improvements which publish, or reproduce, in the present series of papers, a brief he had made since 1818.

abstract of the more important of his views, with such It is not easy to understand why M. Civiale did not describe additional observations as his more lengthened experience his improved apparatus in a clearer manner. Perhaps he did enables him to attach to them. In doing this he candidly not think it prudent to communicate all he knew to profes- confesses that he does not anticipate producing any immediate sional men, who had already evinced so strong a determination or powerful impression in their favour; for it is not easy to to defraud him of his due. However this may be, we are relinquish preconceived opinions and adopt others apparently compelled to take for granted the conclusions of Baron Percy's incongruent; all he hopes is, that they may excite attention, report in 1824. In January of that year, M. Civiale addressed and, before rejection, receive a fair investigation : and this to the Institute a memoir, which was immediately referred to under the conviction that if ultimately adopted, they will tend Barons Percy and Chaussier, the same reporters who had been to reduce the science of midwifery to simplicity and harmony, appointed by the Faculty of Medicine in 1818. This time, M. and, by rendering superfluous the numerous, and in many inCiviale was more fortunate. On the 13th of January, he per- stances supposititious modifications of labour, improve

greatly formed his first operation in the presence of the commissioners, the principles and practice of the obstetríc art. Such, at and the patient was frced from his stone in two sittings. In least, have been the results of his own experience of nearly the second patient operated on, (February 4,) the stone was half a century.

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DR. POWER ON THE PHYSIOLOGY, PATHOLOGY, AND PRACTICE OF MIDWIFERY.

5

The Anatomy of the Uterine System, unimpregnated or gravid, Active Labour. The above preparatory stage having been is so well known, that it is purposed only to notice such facts accomplished, the uterine muscles fall into contraction, the 25 more particularly connect themselves with the principles to more immediate exciting cause of which will hereafter be conbe advocated in the present papers. The gravid uterus may sidered; they now compress the contents of the womb with properly be divided into its body and its cervix, each possess- more or less force. Assuming the uterus to be a regular and ing certain interesting peculiarities of structure. With respect uniform sac, whose parietes were throughout of equal thickness to the former-the body of the uterus-the more important and strength, the result of such compression would be to impel fact to be noticed is, that its fibrous or muscular fasciculi are the contents towards their common centre, and no tendency to dot disposed wholly or principally in those regular longi- expulsion would be induced. But this is not the case; the tudinal and transverse layers which many obstetrical physio: orificial and cervical parts possess few, if any, muscular fibres, logists have laid so much stress on; but the majority and and are of a distensible nature, and therefore give way to the stronger bundles of them run in all manner of directions pressure, so as eventually to form an opening, through which throughout the whole of the body of the womb, as will be the contents of the uterus are expelled. evident on consulting the admirable descriptive plates of Dr. This expulsive property of the uterus, termed the parturient Hunter. The uterus is, in fact, an organ intended to contract nisus, or vis expultrix, doubtless is produced by a determination at all points at one and the same instant, and its muscles are of nervous principle to the organ, dependent on its peculiar so disposed as to ensure this effect, the grand object being, in nervous organization. The precise nature of the latter has not the act of parturition, to compress the contents of the womb yet been fully demonstrated; but it is generally assumed that at all points of their surface, as it were, towards a common the effect is connected with two distinct kinds of nerves, the centre. For reasons which will hereafter be rendered evi: one termed nerves of sensation, the other nerves of motion; dent, it is proposed to term the gravid uterus, as felt through and that an impression or irritation applied to the former is the parietes of the abdomen," the utero-abdominal tumour.propagated or conveyed to the latter: the subject, however,

The Cerriz.-The lower or cervical portion of the uterus will be more fully entered upon in the subsequent papers. presents essential differences from the body; it contains few,

It is practically important to be able to determine the preif ady, muscular fibres, and consists of an elastic or expansive its energy; for these points are by no means proportionate to

sence of this uterine contraction, and, if possible, the degree of tissue; while the one is ordained for contraction, the other is in the sufferings of the patient—nay, the most painful, and it may tended to dilate. Placed at the lower or more depending part be added, protracted cases, are not unfrequently entirely of the womb, the cervix, at what may be termed the line of divested of it. There are two especial modes by which it is to demarcation between it and the body, is connected with the vagina, into which it, in the unimpregnated state, projects, its bedistinguished: one, by an examination of the utero-abdominal more dependent or centrical part being perforated by an examination of the utero-vaginal tumour. In the first case, if

tumour, originally introduced by the author,* the other by an opening extending into the uterine cavity, and which is named the hand be applied to the utero-abdominal tumour when the the os uteri: the whole forming what may be designated as contraction is absent, it will be found in a comparatively the cervical or orificial parts. A finger introduced per vagi. Aaccid state; parts of the child may, indeed, be distinguished, nam would detect a more or less bulging kind of tumour, but the general feel is that of compressibility. As the con

which by way of distinction may be nained the utero traction commences, the compressibility changes gradually ! saginal tumour.” In the latter periods of gestation this pro into a tense hardness, so that, to speak emphatically,

the part i tuberant cervix experiences changes, to be hereafter 'ad- becomes solid as a board; the more decided the effect is, the

Ferted to.
The nervous constitution of the uterus is a subject of high

more vigorous is the accompanying action. This mode of exaimportance; suffice it for the present to give a brief abstract mination affords a delicate and excellent means of " trying a of the clear and accurate description of Dr. Hunter,

in his pain," and the information it gives is uniformly correct, its work on the Gravid Uterus. The upper part of the uterus presence evincing the existence, and its absence the want of matie nerves; the lower part, and particularly the cervix and been ascertained to be favourable, it may obviate the

necessity receives minute nervous branches from the renal and sper true uterine action. It will not indicate the state of presenta

tion or the progress of the case; but, when these points have ragina, from the larger division of the hypogastric nerve for frequent examination per vaginam, while the information which expands itself like the sticks of a fan upon the parts it is capable of affording may be acquired even through the supplied by it, the greater number of rami running to the os ateri and adjacent parts. By virtue of this supply, it may be mination of the utero-vaginal parts, made by an introduction

dress of the patient, without apparent interference. An exainferred that the cervical parts are possessed of a sensor cha; of the finger per vaginam, affords, as far as the utero-vaginal racter, and are more immediately connected with the spinal brain; while the body of the

uterus is mainly connected with tumour itself is concerned, precisely analogous information, the great sympathetic and ganglionic system, which renders it with the important additions, however,

that it detects the preDormally, like the heart and viscera, an involuntary and in sentation and actual progress the case has made, and is making i essible organ.

under the action at the time going forwards, from which ipfer

ences of the first consequence have to be drawn. These, how. Normal Parturition or Labour takes place when the growth ever, it is not necessary here to specify. I of the fætus is sufficiently developed to enable it to exist in- The contraction of the uterus, when strictly normal, is inde

dependently of its maternal system. There are two important pendent of volition, and not necessarily attended by painful I series of actions preparatory to its commencement which sensation; for at the commencement of the paroxysm, either most be noticed.

an abdominal or vaginal examination will detect strong conIn the first place, the cervix uteri, soon after the traction before the patient is in any degree aware of its supersixth month of pregnancy, experiences a gradual oblitera vention; it is only when a forcible pressure is made on the tion, which is completed at the end of the ninth month. parts constituting the passage, that she becomes conscious of How far this arises from an expansion or absorption of its it, and then the sensation is analogous with what accompanies sabstance has not been determined; that it is not occa ordinary fæcal and urinary evacuation. The uterus is theresioned by expansion produced by the growth of the contents fore entitled to be regarded, not only as an involuntary, but as o the uterus, may be inferred from the fact, that at no time an insensible organ. during gestation does the womb, unless it be under actual

Independently of the above, other arguments may be ad. contraction, afford any evidence of being full of its contents, duced to show that pain is not an absolute or necessary con, tat lies in a flaccid state around them, like a bladder partially comitant of parturition. Those writers who have advocated filed with water. The result is, that it now resembles a regular, the contrary with respect to the human female, admit that uniform sac, with its orifice at the lower and more dependent the lower animals are exempt from it, and which they have part, the contents lying in approximation with the os uteri. Secondly. For a few days before labour the uterus is found attempted to account for by referring to a distinction in the

structures concerned. apparently diminished in its volume. This arises from the “ Human parturition, from the mechanism of parts consupervention of a minor contractility, distinct from that con- cerned, must be difficult, and that of animals, from its nature, traction which takes place in active labour, inasmuch as it is is and must be easy.”+ more permanent, and unaccompanied by sensation, and may If this mechanism gave rise to necessary difficulty in women, therefore be designated as the permanent or insensible con- as it is precisely or nearly the same in all women, they ought traction; its effect is, to bring the muscular tissues of the uterus all to experience precisely or nearly, quoad hoc, the same degree into closer approximation with its contents, and it probably of pain or difficulty. This, however, is not the case; and even assists in completing the obliteration of the cervix, and in throwing off the gelatinous plug which has previously sealed

* Treatise on Midwifery, first edition, p. 24 ; second edition, p. 7, &c. up the mouth of the womb.

+ London Practice of Midwifery, p. 124.

6

MR. BEHREND ON CHLOROFORM INJECTIONS IN THE TREATMENT OF GONORRHEA.

ON THE

SURGEON TO THE LIVERPOOL DISPENSARIKS.

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the same woman will in one labour experience an excess of
pain and protraction, and in another it will be quick and easy,
the difference in the two cases depending on physical and not EMPLOYMENT OF CHLOROFORM INJECTIONS
mechanical causes. Again, if the theory were correct, other IN THE TREATMENT OF GONORRHEA.
animals ought to be exempt from certain difficulties to which
women are liable, which also is not the case; for when

BY HENRY BEHREND, Esq., M.R.C.S. Eng., civilized or domesticated, they occasionally bring forth their young with pain and difficulty. Thus it is well known that the forest varieties of sheep are much safer in yeaning than I HAVE much pleasure in bringing before the notice of the the more cultivated breeds. The author has known two profession a new method of treating gonorrhea, which, as far instances of cats, who had previously expelled their young as my experience hitherto enables me to judge, bids fair to be with facility, suffering intense pain in parturition, one of equally well adapted for most of the varieties of this tedious them dying in consequence, and the other relieved by the use and frequently intractable disorder. It consists in the emof friction.

ployment of chloroform as an injection, without the use of any An unyielding state of the soft parts constituting the passage other remedial agent whatsoever, either constitutional or has been generally considered among the more influential local, except, of course, in such cases as present complications causes of pain in parturition; and it cannot be denied that demanding special treatment. In the first few cases in which under an abnormal or morbid condition their resistance I employed the chloroform, I directed it to be injected in its cannot be overcome without more or less painful sensation pure and unmixed form; but I soon found that the pain which being induced; but if this necessarily took place under healthy it occasioned was too severe to be borne, though at no time states, no woman in health could escape it; and yet we find in were such complaints made of it as so frequently follow the many instances, and even with respect to whole nations, that use of the nitrate of silver. Accordingly, I now have it mixed parturition is almost entirely exempt from pain. In fact, the with twice the quantity of mucilage; nor does its action appear soft parts are by nature adapted to bear considerable less prompt from this diminution of strength. The method of distention without material distress; even the os uteri, injection is the usual one, no special directions being necessary. in ordinary labour, may frequently be stimulated with The frequency must depend upon circumstances. "I have not the finger, without inducing paid, as the author has frequently as yet found it advisable to order it more than thrice a day, noticed.

but recommend its employment once a day for at least four There are a few points relative to uterine action, which tend days after all discharge has ceased. Beyond the ordinary to practical utility. When the os uteri is well dilated, the mem- avoidance of stimulants, undue exposure, &c., no instructions branes may be expected to rupture; if this be much delayed, it whatever are needed; and in no instance in which I have as is proper to break them; but it should only be done while the yet tried this plan has it been found necessary to confine the contraction is at its greatest intensity, and if it has commenced patient to the house, nor have any evil results followed the receding, should be deferred until the next paroxysm. The application of the chloroform to the diseased surface of the reason of this is, that in the one case the uterus remains urethra. closed on its contents, and its action will soon repeat; while My object in publishing the following cases is a desire that in the other, the liquor amnii escaping, it is left with a propor- the value of the remedy may be tested by those who have tionate vacuity, which acts as an equivalent to a removal of equal opportunities with myself for the institution of such insensible contraction, with a corresponding diminution of experiments in the field of practice opened by public apsucceeding uterine action, sufficient to suspend the progress pointments, as I am of opinion that the concurrent testimony of the case for a greater or less period, or until the uterine of many is absolutely essential before any method of treatfibres have recovered their tone.

ment, however satisfactory it may appear to individuals, The membranes being ruptured, the head of the child should be considered as fully established. descends through the os uteri into the vagina, and, by the in: Case 1.–Oct. 20, 1851:

Mrs. F, aged forty-eight, com: creased stimulus, excites the mucous follicles to secrete a greater quantity of lubricating, fuid, which materially facili- has undergone no treatment. Ordered the chloroform, in its

tracted gonorrhæa from her husband about a week ago, but tates the delivery. If this be defective, as will frequently be unmixed state, to be injected thrice a day; no medicine what. the case, from various causes, and particularly the one just ever to be taken. It caused violent sinarting pain, which recited, the practice of introducing lubricating unguents is lasted about an hour after each injection; but no dysuria or so far founded on a wrong principle, the more important other unpleasant symptom followed. The first day the disobject to be held in view being to increase uterine action, charge increased in quantity, and became more viscid; but on which, restoring the pressure on the mucous surface, the the second it had rapidly diminished; and on the third lubricity soon returns. Upon nearly analogous principles, it is essential, the child's to inject morning and evening; and on the fifth the discharge

(Oct. 22) had alınost ceased. The fourth day I ordered her head having been expelled, not to allow the remaining parts had quite ceased. As a matter of precaution, she continued of its body to be hastily drawn away, or at least without the the employment of the chloroform every morning, until the concurrence of uterine contraction; for this will necessarily tenth day, when, no trace of the disorder having recurred, she leave behind a proportionate vacuity within the womb, which finally discontinued it. is not unlikely to interfere with the subsequent expulsion of the placenta, and may not only occasion retention of the after

CASE 2. Gleet.--Jan. 1, 1852: Martha B-, unmarried, birth, but induce hæinorrhage or hour-glass contraction. Let thirty-two years of age, has had a gleet for twelve months, it therefore be an invariable rule to retard, and not to hasten, the discharge varying in quantity, but at present profuse. the delivery of the body of the child. In the delivery of the She has gone through the usual routine of treatment, but has placenta, if it be suddenly removed, the membranes which scarcely given many of the remedies a fair chance, owing to ought to remain attached to it will be liable to be more or

irregular habits of life; is at present taking balsam of copaiba, less broken off, and left behind within the uterus, where, by and using injections of sulphate of zinc, from which she their irritation, they will give rise to severe after-pains, an

derives no benefit. Directed her to discontinue these, and occurrence which may in great measure be prevented by inject with equal parts of chloroform and mucilage thrice deliberately drawing out the whole of them in an entire

a day. state.

Jan. 5th.—The injection was painful, and at first increased It is partly to secure the above proper contraction of the the quantity and consistency of the discharge; but after the uterus that the use of a properly-adjusted band.ige around the second day this became much less, and is now very scanty abdomen of the patient is essential throughout the whole of and thin. She suffers no other inconvenience, and is much the process. The appliance of the bandage was formerly only elated at the prospect of recovery. The catamenia having recommended after the labour was finished; and the author

come on, I deemed it prudent to suspend all treatment. believes that he was the first who adopted its use during the

8th.- Last night the catamenia ceased; there is now a process. He generally applies it immediately on entering the slight gleety discharge. Ordered to resume the injection. patient's chamber, and tightens it from time to time, as the

12th.-Not much change; the injection causes severe but case proceeds; and particularly after the head and body of temporary pain. To use it half the strength for the future; the child, and the placenta, have been expelled. His patients that is, one part of chloroform to two of mucilage. generally derive great comfort from its use; and in his prac

15th.— The discharge has quite ceased, and she is perfectly tice placental difficulties and after-pains have been compara

well. tively unknown.

19th.-Continued injecting once a day till this date; no

return of the symptoms. Janc, 1852. (To be concluded.)

CASE 3.-Jan. 12, 1852: John S

, aged twenty-four, first

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