OBSTETRICAL SOCIETY OF LONDON
2
618 like a gland, occupying the situation of the lymphatic gland ordinarily found in this situation ; but the section showed this mass to be continuous with a deposit involving the whole thickness of the triceps. A right fibula was also shown, with several muscles attached. In connexion with the flexor longus pollicis, just above the middle third, was a tumour about an inch and a half in length, and an inch in transverse diameter. Another smaller tumour was seen about the middle of the spe- cimen an inch in length, and half an inch measured trans- versely. All these tumours, with others obtained from the same subject (all of which are now preserved in St. Thomas’s museum), presented, under the microscope, muscular tissue in- filtrated with inflammatory elements. Mr. SPENCER WELLS presented the pelvis of a woman who had died of TETANUS AFTER PERINEAL SUTURE, performed for the relief of Prolapsus Uteri with Cystocele and Rectocele. The symptoms in this case had pointed to injury of the perineal nerves, and increased reflex excitability of the spinal cord, as the cause of the tetanus; and Mr. Wells had been anxious, therefore, to have a minute examination made of the nerves implicated in the operation. Mr. Couper, demonstrator of anatomy at the London Hospital, had made the post-mortem, and had removed the whole of the pelvis and afterwards made a careful dissection. He stated, and the preparation exhibited showed, that neither the hypogastric plexus, nor any of the nerves given by it to the lower part of the bladder and rectum, afforded any signs of inflammation. The sacral canal was laid open from behind, and the cauda equina and sacral nerves appeared healthy. Except in the vicinity of the united wound, and in the mucous coat of the bladder, there was no trace of inflammatory change in the -pelvis. The mucous surface of the bladder was speckled with small blood-stains, grouped in patches, and apparently seated in the substance of the mucous membrane. The gastric mucous membrane was found in a similar state, owing probably to the fa.ct that the woman had been for forty-eight hours before death almost constantly under chloroform. This preparation also showed very distinctly Rouget’s Utero- Ovarian Muscle, Mr. Couper having the credit of being the first to demonstrate it in this country. It was plainly seen to consist of bundles of muscular fibres, forming a fan-shaped muscle between the folds of the broad ligament, and showing that the uterus, the ovary, and the Fallopian tube, are enve- loped in a common muscular membrane, and that the contrac- tion of the bundles of muscular fibres would draw the ovary and the fimbriated extremity of the Fallopian tube together; and, by inclosing the venous plexuses near the ovary, would complete the erectile system of the female organs of generation, so beautifully delineated by Dr. Savage, and explain very simply the mechanism of ovulation. OBSTETRICAL SOCIETY OF LONDON. WEDNESDAY, DEC. 7TH, 1859. DR. RIGBY, PRESIDENT, IN THE CHAIR. THE gentlemen proposed as Honorary Fellows at the last meeting were duly elected. Twelve gentlemen were elected, and twelve proposed for election, as Ordinary Fellows. STATISTICS OF MIDWIFERY PRACTICE, FROM JULY 2, 1808, TO DECEMBER 31,1858. BY H. W. BAILEY, F.R.C.S. (THETFORD). In order to afford an opportunity of comparing provincial statistics with those of town and hospital practice, the author . submitted the results of fifty years’ extensive practice in niid- wifery. The births amount to 6476—3290 males, and 31S6 females. There were 53 cases of twins-63 males, and 38 females. 21 were still-born. There was 1 case of triplets, which lived till the next day. There were 6120 cases of head presentation, and 356 preternatural cases. Presentations of , the face to the right side were very tedious; in such cases, turning or the use of the forceps was advisable. In 44 cases, the arm or hand presented. In 21, the funis presented; one or two of these were still-births. Of breech cases, 45; when the face presented to the front, these cases required the aid of the forceps to save the child. In 40 cases, the face, and in 9 the abdomen or back, presented. In 180 cases (primary), the feet presented. In 17 cases, placenta pra;via existed. In 1. the placenta was expelled first. As a rule, the author dilates gradually and turns in these cases. All cases were successful, both to mother and child, if at the full time. Hsemorrhage was fatal in 2 cases, attended by midwives. There were 2 cases of sudden death after labour; no apparent cause. Em. bryotomy was performed only twice. Instrumental aid was afforded in 112 cases. The total maternal mortality from all causes was 13. A tabular statement was appended, showing the number of deliveries in the respective months of the year. I CASE IN WHICH THE DELIVERY OF A VEPY LARGE LIVING CHILD WAS EFFECTED BY MEANS OF THE LONG FORCEPS. 4 BY CHARLES WALLER, M.D. ’i The case was brought forward on account of the extreme size of the child, which, on delivery, was found to weigh 15lbs. 15 oz After about thirty-six hours’ ineffectual labour, Dr. Waller applied the long forceps, a good part of the head being still above the brim, and delivered the child, which was a female, alive. A NEW NURSING-CRADLE* was exhibited by the inventor, Mr. C. WRIGHT. ON THE RISK TO LIFE OF FIRST AND SUBSEQUENT PREGNANCIES. BY ROBERT BARNES, M.D., F. R. C. P., ETC. The author wished to draw the attention of the Society to the determination of the question as to whether first pregnan- cies were to be considered as more hazardous to life than sub. sequent ones. The question was one of great interest as bearing upon life assurance. It was not sufficient to know the amount of risk for all pregnancies, which we were at present, indeed, in possession of. Excluding deaths from puerperal fever, the Dublin Hospital statistics showed that 1 in 100 of primiparse died, and 1 in 200 of the multiparæ. But as the statistics of private practice only were capable of affording satisfactory in- formation, he would suggest that the Fellows of the Society be invited to contribute to the settlement of the question. A tabular form for the purpose he submitted to the Society. Dr. TYLER SMITH agreed with Dr. Barnes as to the risk in- curred by women in first labours, but it was the custom of the assurance office with which he was connected-the New Equit. able-to assure the lives of healthy women pregnant for the first, or any other time, at the ordinary rates. The rates of life assurances were framed upon the average duration of life in average lives. At all ages, the expectancy of the continuation of life was somewhat greater in the female than the male; so that they were the best lives for assurance. As regarded the ques- tion of married or single women, there could be no doubt that there were certain risks incidental to child-birth, but single and childless women were subject in an increased degree to certain disorders of the nervous system and to uterine and ovarian tumours, which rendered them, if anything, less eli- gible than child-bearing women for life assurance. Dr. MURP .Y believed the principle of the New Equitable Society to be the correct one. The statistics of the Dublin Hospital were not applicable to the settlement of this interest- ing question for special stated reasons; and, in fact, arguments based on statistics generally required to be received with very great caution. ON THE TREATMENT OF MOLES AND PREMATURE EXPULSION OF THE F(ETUS. BY AXCELL BALL, M.R.C.P. ED. (SPALDING). In cases of severe hæmorrhage after the expulsion of the fcetus, the secundines being retained, the author uses one of three instruments exhibited, for the purpose of removing the retained substance. The instruments consist of a two- and a three-bladed forceps, which admit of being used through the speculum. CASE OF RETROFLEXION OF THE GRAVID UTERUS DURING LABOUR AT TERM. BY HENRY OLDHAM, M.D., F. R. C. P., ETC. The patient was pregnant for the first time, and had been in labour for several hours when Dr. Oldham saw her. On exa- mination, the fundus uteri, with the head of the child, were found filling the pelvis ; the os uteri drawn up above the pelvic brim, and reached with the utmost difficulty. The condition had apparently existed from the beginning of pregnancy. By * See THE LANCET, vol. i., 1859, p. 632.
Transcript of OBSTETRICAL SOCIETY OF LONDON
618
like a gland, occupying the situation of the lymphatic glandordinarily found in this situation ; but the section showed thismass to be continuous with a deposit involving the wholethickness of the triceps. A right fibula was also shown, withseveral muscles attached. In connexion with the flexor longuspollicis, just above the middle third, was a tumour about aninch and a half in length, and an inch in transverse diameter.Another smaller tumour was seen about the middle of the spe-cimen an inch in length, and half an inch measured trans-versely. All these tumours, with others obtained from thesame subject (all of which are now preserved in St. Thomas’smuseum), presented, under the microscope, muscular tissue in-filtrated with inflammatory elements.
Mr. SPENCER WELLS presented the pelvis of a woman whohad died of
TETANUS AFTER PERINEAL SUTURE,
performed for the relief of Prolapsus Uteri with Cystocele andRectocele. The symptoms in this case had pointed to injuryof the perineal nerves, and increased reflex excitability of thespinal cord, as the cause of the tetanus; and Mr. Wells hadbeen anxious, therefore, to have a minute examination madeof the nerves implicated in the operation. Mr. Couper,demonstrator of anatomy at the London Hospital, had madethe post-mortem, and had removed the whole of the pelvis andafterwards made a careful dissection. He stated, and thepreparation exhibited showed, that neither the hypogastricplexus, nor any of the nerves given by it to the lower part ofthe bladder and rectum, afforded any signs of inflammation.The sacral canal was laid open from behind, and the caudaequina and sacral nerves appeared healthy. Except in thevicinity of the united wound, and in the mucous coat of thebladder, there was no trace of inflammatory change in the-pelvis. The mucous surface of the bladder was speckled withsmall blood-stains, grouped in patches, and apparently seatedin the substance of the mucous membrane. The gastric mucousmembrane was found in a similar state, owing probably to thefa.ct that the woman had been for forty-eight hours beforedeath almost constantly under chloroform.
This preparation also showed very distinctly Rouget’s Utero-Ovarian Muscle, Mr. Couper having the credit of being thefirst to demonstrate it in this country. It was plainly seen toconsist of bundles of muscular fibres, forming a fan-shapedmuscle between the folds of the broad ligament, and showingthat the uterus, the ovary, and the Fallopian tube, are enve-loped in a common muscular membrane, and that the contrac-tion of the bundles of muscular fibres would draw the ovaryand the fimbriated extremity of the Fallopian tube together;and, by inclosing the venous plexuses near the ovary, wouldcomplete the erectile system of the female organs of generation,so beautifully delineated by Dr. Savage, and explain verysimply the mechanism of ovulation.
OBSTETRICAL SOCIETY OF LONDON.
WEDNESDAY, DEC. 7TH, 1859.
DR. RIGBY, PRESIDENT, IN THE CHAIR.
THE gentlemen proposed as Honorary Fellows at the lastmeeting were duly elected. Twelve gentlemen were elected,and twelve proposed for election, as Ordinary Fellows.
STATISTICS OF MIDWIFERY PRACTICE, FROM JULY 2, 1808,TO DECEMBER 31,1858.
BY H. W. BAILEY, F.R.C.S. (THETFORD).In order to afford an opportunity of comparing provincial
statistics with those of town and hospital practice, the author. submitted the results of fifty years’ extensive practice in niid-
wifery. The births amount to 6476—3290 males, and 31S6females. There were 53 cases of twins-63 males, and 38females. 21 were still-born. There was 1 case of triplets,which lived till the next day. There were 6120 cases of head
presentation, and 356 preternatural cases. Presentations of
, the face to the right side were very tedious; in such cases,turning or the use of the forceps was advisable. In 44 cases,the arm or hand presented. In 21, the funis presented; oneor two of these were still-births. Of breech cases, 45; when theface presented to the front, these cases required the aid of theforceps to save the child. In 40 cases, the face, and in 9 theabdomen or back, presented. In 180 cases (primary), the feetpresented. In 17 cases, placenta pra;via existed. In 1. the
placenta was expelled first. As a rule, the author dilates
gradually and turns in these cases. All cases were successful,both to mother and child, if at the full time. Hsemorrhagewas fatal in 2 cases, attended by midwives. There were 2cases of sudden death after labour; no apparent cause. Em.bryotomy was performed only twice. Instrumental aid wasafforded in 112 cases. The total maternal mortality from allcauses was 13. A tabular statement was appended, showingthe number of deliveries in the respective months of the year.I CASE IN WHICH THE DELIVERY OF A VEPY LARGE LIVING
CHILD WAS EFFECTED BY MEANS OF THELONG FORCEPS.
4 BY CHARLES WALLER, M.D.
’i The case was brought forward on account of the extremesize of the child, which, on delivery, was found to weigh 15lbs.15 oz After about thirty-six hours’ ineffectual labour, Dr.Waller applied the long forceps, a good part of the head beingstill above the brim, and delivered the child, which was afemale, alive.
A NEW NURSING-CRADLE*
was exhibited by the inventor, Mr. C. WRIGHT.
ON THE RISK TO LIFE OF FIRST AND SUBSEQUENTPREGNANCIES.
BY ROBERT BARNES, M.D., F. R. C. P., ETC.
The author wished to draw the attention of the Society tothe determination of the question as to whether first pregnan-cies were to be considered as more hazardous to life than sub.sequent ones. The question was one of great interest as bearingupon life assurance. It was not sufficient to know the amountof risk for all pregnancies, which we were at present, indeed,in possession of. Excluding deaths from puerperal fever, theDublin Hospital statistics showed that 1 in 100 of primiparsedied, and 1 in 200 of the multiparæ. But as the statistics of
private practice only were capable of affording satisfactory in-formation, he would suggest that the Fellows of the Society beinvited to contribute to the settlement of the question. Atabular form for the purpose he submitted to the Society.
Dr. TYLER SMITH agreed with Dr. Barnes as to the risk in-curred by women in first labours, but it was the custom of theassurance office with which he was connected-the New Equit.able-to assure the lives of healthy women pregnant for thefirst, or any other time, at the ordinary rates. The rates oflife assurances were framed upon the average duration of life inaverage lives. At all ages, the expectancy of the continuation oflife was somewhat greater in the female than the male; so thatthey were the best lives for assurance. As regarded the ques-tion of married or single women, there could be no doubt thatthere were certain risks incidental to child-birth, but singleand childless women were subject in an increased degree tocertain disorders of the nervous system and to uterine andovarian tumours, which rendered them, if anything, less eli-gible than child-bearing women for life assurance.
Dr. MURP .Y believed the principle of the New EquitableSociety to be the correct one. The statistics of the DublinHospital were not applicable to the settlement of this interest-ing question for special stated reasons; and, in fact, argumentsbased on statistics generally required to be received with verygreat caution.ON THE TREATMENT OF MOLES AND PREMATURE EXPULSION
OF THE F(ETUS.
BY AXCELL BALL, M.R.C.P. ED. (SPALDING).In cases of severe hæmorrhage after the expulsion of the
fcetus, the secundines being retained, the author uses one ofthree instruments exhibited, for the purpose of removing the
retained substance. The instruments consist of a two- and athree-bladed forceps, which admit of being used through thespeculum.
CASE OF RETROFLEXION OF THE GRAVID UTERUS DURINGLABOUR AT TERM.
BY HENRY OLDHAM, M.D., F. R. C. P., ETC.
The patient was pregnant for the first time, and had been inlabour for several hours when Dr. Oldham saw her. On exa-mination, the fundus uteri, with the head of the child, werefound filling the pelvis ; the os uteri drawn up above the pelvicbrim, and reached with the utmost difficulty. The conditionhad apparently existed from the beginning of pregnancy. By
* See THE LANCET, vol. i., 1859, p. 632.
619
combined external and internal manipulation the breech wasbrought down, and the fundus pushed up. Delivery was theneffected ; the child was dead. The mother did well. Theauthor remarked on the facts—1st, that the full time had beenreached; 2ndly, that the symptoms were not such as to exciteattention previously; and 3rdly, the possibility of replacernentat this late period.
In answer to a question put by Dr. G raily Hewitt, the authorstated that the patient, when formerly under his care and
single, had, he believed, been the subject of retroflexion.ON SLOUGHING OF THE FŒTAL SCALP AS A RESULT OF TEDIOUS
LABOUR.
BY W. 0. PRIESTLY, M.D., M E.C.P., ETC.
The author related a case, under the care of a midwife, inwhich the head had been impacted for about forty-eight hoursin the pelvis, in a first labour. Eight days after delivery thechild died. On the third day, the back of the head was muchinflamed; later, the scalp assumed a darker colour, and thechild gradually sank. A slough, of the size of a shilling, hadseparated, leaving a wound, which extended nearly to the bone,over the occipital protuberance; and there was extensive ecchy-mosis around almost to the ear on each side; and the peri-cranium was in part separated from the bones. The sloughingin question resulted, in the anthor’s belief, from the long im-paction of the head in the pelvis.CASE OF FIBROUS TUMOUR OF THE UTERUS, ILLUSTRATING A
SURGICAL OPERATION FOR ITS CURE.
BY 1. BAKER BROWN, F. E. C. S. E.
In a woman aged forty-nine, ill for six years, there wasfound an abdominal tumour, extending half-way to the
umbilicus, composed of the uterus, enlarged by the presence ofa fibrous tumour. The os uteri was incised, and the tumourbrought into sight. The author then proceeded to operateupon it by piercing it in the centre, cutting out a portion,much in the manner of coring an apple. Through the cavitythus formed as much as possible of the surrounding tissue wasbroken down. A copious discharge occurred for the next fewdays; and at the end of four months a slightly enlarged uteruswas all that could be detected. The principle on which theoperation in question (which, the author observed, had beenperformed by Atlee and Recamier) was adopted, was the know-ledge of the faact, thit when polypi are ligatured the whole ofthe growth perishes—not only that on the distal side, but alsothat on the other side of the ligature. By removing a portionof the fibrous tumour, the same effect-the destruction of thewhole—was in this case obtained.
Dr. BARNES believed Atlee’s operations had been attendedwith great mortality. He would suggest that Dr. Simpson,just elected an honorary fellow, should furnish the Societywith the results of his enucleation practice.
Dr. PRIESTLY believed that Dr. Simpson had abandoned in-terfering with large fibroid tumours of the uterus by operativemeasures.
The PRESIDENT remarked on the varying degrees of themenorrhagia attending cases of fibroid tumour.
CASE OF EXTREME EMACIATION, THE RESULT OF OBSTINATEVOMITING IN PREGNANCY.
BY W. TYLER SMITH, M.D., F.R.C.P., ETC.A girl, aged nineteen, unmarried, was admitted into St.
Mary’s Hospital in July last. Obstinate vomiting, at first
supposed to depend on cerebral disorder, continued from thetime of her admission. She became so extremely reduced inflesh, that at the end of six weeks her weight was only forty-seven pounds and a half. At this time she was unable to movein bed; delirium was frequent, bed-sores appeared over thesacrum and nates, and she appeared to be dying. Pregnancywas now suspected. The catamenia were found to be absent ;the breasts were full, notwithstanding the emaciation of therest of the body; and the uterus had increased in size. Re-medies had been of no avail. She was too weak to permit ofartificial abortion. A nurse was put by her bedside to give hera single teaspoonful of nourishment every half hour. The bodywas rubbed with oil, and beef-tea injections were administereddaily. Under this plan the sickness ceased ; the quantity ofnourishment was slowly increased, and she improved in
strength, and became comparatively stout. Pregnancy went onto December 3rd, when she miscarried at the fifth month, andis now recovering.In answer to a question by Mr. Cleveland, Dr. Tyler Smith
stated that the enemata given were retained.
CASE OF HYSTERIA SIMULATING IN THE MOST PERFECTDEGREE NATURAL LABOUR.
BY RICHARD HODGES, M.D. (ROCHFORD).The author was engaged to attend a woman said to be in
the fifth month of pregnancy. Four months afterwards he wassent for, the patient being stated to be in labour. The painswere found to be severe, and like those of the last stageof parturition. On examination, however, a tumour was foundto present, which turned out to be the bladder, distended andprolapsed. There was no pregnancy.The PRESIDENT then announced that the first session of the
Society, which had been a most successful one, was now broughtto ê1 close. The first meeting of the next session would be held,
on Wednesday, January 4th, 1860.
Reviews and Notices of Books.The Mineral Springs of Vichy: a Sketch of titei2- Clierraicul and
Physical Characters, and of their Efficacy in the Treatmentof various Diseases. By The Author of the " Spas of Ger-many," &c. pp. 243. London: Charchill.
UPON the banks of the Allier, at an hour’s distance from oneof the lesser stations on the Orleans and Lyons Railroad, liesthe once remote village of T’i;;us Calidas of Theodosius the
Emperor, and now the fashionable and highly-reputable spaof Vichy. " Vicus Calidas" being transformed into " VillageChaud," the nomenclators, who clip names by halves, takingvi from village, and cha (which they pronounce chi) from cha?td,constructed the far-famed name of Vichy, at present a most im-portant place in the estimation of hydrologists. In very ancienttimes—perhaps during the lirst and second centuries—the" Aquæ Calidæ" of Vichy were in great request; even the great
Cæsar, our author imagines, may have tasted of them on hisreturn from the siege of Gergovià. But a cloud settled uponVichy, and for a time it was lost to fame, when Lonis XI. raisedit again into importance. With variable fortune and renown, itstruggled on pretty well against the rivalries of hostile spasuntil 1853, when it appeared amongst the latter as determinedto earn for itself a positiun of high standing.
" Since the year 1853, when a decree of the French Govern-ment placed the neglected mineral establishment of Vichy inthe hands of a highly respectable and responsible society ofshareholders, that spa has been rahicli y emerging from com-parative obseirity into the noon-day of popularity. Its name,but littlc, if at all, known in England until within the lastthree or four years, is now in the mouths of many hundredvisitors, who have returned from Vichy more or less benefitedby its waters, to which they had recourse on the recommenda-tion of French physicians, or their works. English nractitioners,especially such as are consulted by chronic invalids, eager toseek health abroad from mineral waters, or the mere influenceof foreign travels, have adopted the views and panegyrics oftheir Continental brethren, and the names of Vichy, VichyWctters, Vichy baths, and Vichy pastilles, are accordingly to beheard every day in the drawing-rooms as well as the sick roomsof the rich of the metropolis. "—p. ii.
Vichy affords mineral waters of one kind only-viz., thealkaline class, but which differ at the various springs in theirdegrees of temperature. In certain minor points there are someother differences, no doubt, at the various springs, but the grandchemical feature of all the founts is their great richness in thepossession of the bicarboaute of soda. Every pint of the water,speaking generally, holds in solution from thirty-five to fortygrains of this alkaline salt, besides other ingredients. In their
alkalinity the waters of Vichy are inferior only to three or fourother known springs in Europe. But it is not alone for this
quality that they are famous : the waters of Vichy are warmwaters, and some are of a high degree of temperature. Thewaters of the " Cetestin" have a temperature of 61° Falir.;. thoseof "L’Hôpital," one of 878; and those of the " Piuts Carre,"one of 113° Fahr. In two sources of power and virtue thesesprings of Vichv are thus very rich. They are highly alkaline’
