Imágenes de páginas
PDF
EPUB

what the result to the child would be. Dr. Carpenter, in the last edition of his work on "Human Physiology," says :-"No soundly-judging physician of the present day is likely to fall into the popular error of supposing that “marks” upon the infant is to be referred to some transient, though strong impression on the imagination of the mother; but there appear to be a sufficient number of facts on record, to prove that habitual mental condition on the part of the mother may have influence enough, at any early period of gestation, to produce evident bodily deformity or peculiar tendencies of the mind. The error of the vulgar notion on this subject lies in supposing that a sudden fright speedily forgotten may exert such a continual influence on the nutrition of the embryo as to occasion any personal peculiarity.” Some very interesting remarks on monstrosity in children, with some remarkable examples of the condition, may be found in Dr. Montgomery's "Signs and Symptoms of Pregnancy." The subjoined case is offered as a contribution to the literature of this obscure and difficult subject. ** A girl, 12 years old, was in Lucas Ward in the month of April last, for the treatment of an attack of lepra. She at once became a nine day's wonder in the hospital, under the name of the “monkey child," for it was found that the left arm and the greater part of the trunk presented a precise resemblance to the like parts of a monkey. The arm was long, thin, and withered looking, the scapula prominent, and the skin deeply stained with dark brown pigment, and covered with an abundant crop of lank tawny hair, some of which was nearly two inches in length-in fact, the likeness of these parts to the corresponding parts of a monkey was so complete that any one, judging by them alone, would almost certainly think she was a champanzee. Her mother stated that when she was three months pregnant with the child she was very much terrified by an organ monkey, which suddenly jumped upon her back as she was passing along the street.

The following remarkable instance was related by Mr. Paget, as he went round the wards, as having taken place under his own observation :-A person when pregnant with her first child chanced to shake hands with a man who, by an accident some years previously, had lost the middle fingers of the right hand, the index and little fingers, from long practice in grasping objects, having afterwards fallen almost into the shape of a lobster's claw. Being a nervous and very sensitive woman, she was startled and distressed when she became aware of the condition of the hand, and for several days she could not dismiss the recollection of it from her mind. When her child was born, it was found that the middle fingers of both hands, and the middle toes of both feet, were, absent. After an

[ocr errors]

interval of five years, during which she had had four perfectly formed children, and, being now pregnant with a fifth, she again encountered the man, and was again obliged to shake hands. She was so much disturbed by this occurrence, and so impressed with the idea that the child would be deformed, that in the evening she wrote down the event and her conviction regarding the child. When the child was born it was deformed exactly as the first had been.

LACERATION IN A NEW-BORN CHILD. Mr. R. King Pierce showed to the Obstetrical Society of London April 5, 1865, a foetus, born at full time, and exhibiting at birth two lacerations: one extending through the integuments transversely across the abdomen, about the level of the scrobiculous cordis; a second one across the throat, exposing all the vessels and muscles of the neck. The two lacerations had all the appearance of incised wounds; but the evidence was clear that they had not been produced by an act of violence other than of rapid delivery.Lancet, June 3, 1865.

[ocr errors]

Materia Medica and Chemistry.

ON THE THERAPEUTICAL PROPERTIES OF HEMLOCK.

By Dr. GARROD. Hemlock has long been employed in medical practice, but many complaints have been made as to the uncertainty of its operation. In the London Pharmacopoeia the leaves are employed, and a tincture, an ointment, and an extract were made from them. But as the activity of hemlock depends upon the presence of a peculiar fluid alkaloid, named conia, which readily undergoes decomposition when exposed to the air, the dried leaves must lose their efficacy by keeping, and hence it appeared to the committee who prepared the British Pharmacopæia that the fruit should be substituted for the leaves in the officinal preparations, as the former contains conia in a more concentrated state. A juice of the fresh leaves, the succus conii, has also been introduced into the British Pharmacopæia, a little spirit being added to the liquid to prevent decomposition. The tincture of the British Pharmacopoeia, termed tinctura fructus conii, is made in the proportion of two ounces of the fruit to a pint of spirit. Dr. Garrod has lately made a series of clinical experiments with hemlock, the result of which shows that it possesses far less energy than is generally supposed, but the tincture of the British Pharmacopoeia (made with the fruit) is more efficacious than that of the London Pharmacopoeia (made with the leaves). Of the latter Dr. Garrod administered doses of from one drachm to half an ounce three times a day in about twenty cases, and latterly he gave a fluid ounce at each dose without producing any discomfort to the patient, who indeed exhibited no symptoms at all from the employment of the drug. The tincture employed was supplied by the most respectable pharmaceutical establishments. The tincture of the British Pharmacopoeia, however, is more active ; for in the case of the patient who took a fluid ounce of the London tincture for a dose, it was found that when the tincture of the fruit was substituted, five drachms were sufficient to cause the derelopment of some symptoms, but these were only slight. Dr. Garrod considers, therefore, that the new tincture possesses at least twice the strength of the old, but that it is not very potent.

Dr. Garrod doubts very much the efficacy of conium in any form in relieving the pain or altering the diseased action in carcinomatous affections; but he thinks that in large doses it may be advantageously administered in cases of severe spinal disease, both structural and functional. In paraplegia, when there exists a sub-inflammatory state of the spinal cord, as indicated by pain in the back and startings of the limbs, hemlock is of great service; and Dr. Garrod has often seen the incontinence of urine checked by the drug. Conium appears to be beneficial where strychnia is injurious; and Dr. Garrod suspects that in very many cases of paraplegia, even when the ordinary symptoms or irritation of the spinal cord cannot be detected, some lurking action may exist which is aggravated by the employment of strychnia, but is generally soothed by hemlock. Dr. Garrod relates a case in which strychnia had been administered with the effect of aggravating the symptoms, and more especially the incontinence of urine, but in which the employment of hemlock in gradually increasing doses was followed by positive alleviation and eventual convalescence. The dose of the tincture of the British Phar. macopoeia may range from half a drachm upwards, according to the nature of the case and the urgency of the symptoms.- Medical Times.

Surgery.

LIGATURE OF THE ILIAC ARTERY.

A case of aneurism is described in the Dublin Medical Press, having oecurred in the city of Dublin Hospital, under the care of Professor

a

Wm. Hargrave, in which ligation of the left common iliac artery was resorted to. Per se the operation was successful, as the artery was entirely and permanently occluded, without the following of secondary hemorrhage. But the patient died from exhaustion, the result of pelvic abscesses and hemorrhage established in the aneurismal sac through collateral circulation.

Without going into a history of the case we give the account of the operation and of the autopsy.

Operation, April 29th, 1865. Patient well under the influence of chloroform before and during the operation. An incision was made from the point of the last rib, slightly curving downward to Poupart's ligament, mid-distance between the anterior superior spine of the ilium and symphisis pubis about eight inches long through the superficial fascia; the three broad muscles were next carefully divided from below upward and from angle to angle of the incision. Any hemorrhage, was venous with the exception of the internal branch of the circumflex ilii vessel, which was sliced. A ligature was tied on each side of the opening, and the vessel divided. The transversalis fascia was perfectlycleansed and free from any blood; it was very strong. The smallest possible portion of it was pinched up in the forceps, and found by its transparency to be free of the peritoneum, which was divided on the director on the entire extent of the wound; the peritoneum was freely exposed, and the color seen beneath it. The peritoneum was removed from the liac fossa to the mesial line of the body with the greatest facility, with more ease than in the dead subject it carried with it firmly adherent, the ureter. The aneurismal sac, occupying the external iliac artery, remained almost in a state of repose, i.e., did not project into the wound, as has occurred in similar operations. It was well defined at the cardiac or proximal end, and corroborated what was ascertained before the operation, of dipping deep into the pelvic cavity, perhaps compressing the external iliac vein, so accounting for the great oedema of the entire of the left limb. The common iliac artery was now exposed and visible to the naked eye; the vein was not equally apparent. The separation between these vessels was easily effected with the finger nail, and a hempen ligature passed under the artery from within outward. In compressing it on the aneurismal needle, all pulsation on the aneurism completely ceased, it becoming 80 flat as to have disappeared. The genitor-crural nerve was embraced by the ligature in the first instance, from which it was eccluded. The extreme sensitiveness of this perve was evident from the fact that when very gently touched, to free it from the ligature, the patient was roused to perfect consciousness from a deep anesthetic sleep. This occurred twice.

The artery was tied about half or three quarters of an inch above its division into the external and internal iliacs.

The patient died July 11th, seventy-third day after the operation.

Post mortem ecumination, (Drs. Tufnell and Croly.) An incision made from umbilicus to symphisis pubis, and an other from same point to ant. super. spinous process of the ilium. Muscles and fascia traversalis next divided; intestines adherent in left iliac fossa, by firm bands of lymph, the result of inflammation. The intestines being drawn up, the fascia iliac was exposed, covering the iliacus internus muscle ; ureter was observed crossing the anterior surface of the common iliac artery, just at its bifurcation. The aneurismal tumour which was soft, and fluctuating to the touch, measured five inches by two and a half behind, and to its outer side lay the anterior crural nerve, flattened and expanded. The abdominal aorta was exposed as high as the origin of the inferior mesenteric branch ; it presented a normal appearance as regards size; an inch above its bifurcation into the common iliaca, a calcareous deposit about the size of a four penny piece was seen protruding through the coats of the artery; it occupied the right side of the vessel.

The left common iliac artery (that on which the ligature was applied) was much smaller than the corresponding artery of the other side; there was a fibrinous clot in it just below its origin from the aorta—the vessel was severed by the ligature, half an inch above the bifurcation into the internal and external iliacs. On passing a probe through the internal into the common iliac, it was stopped by the adhesion of the vessel at the distal side of the ligature. The same occurred on passing a probe through the aorta into the common iliac. The common iliac vein was closely adherent to its artery, and the external vein was pressed on by its artery. Femoral artery and vein healthy, and of natural size. Iliac fossa unusually dense, and closely bound to the vessels ; a large oval lymphatic gland occupied the left side of the common iliac artery, which was seen during the operation of a bluish color. The pelvic cavity was filled with unhealthy pus; the pelvic bones sound and not indented by the tumor, Internal epigastric artery slightly enlarged. A probe passed through it into the aneurismal sac touched a soft fibrinous clot. Walls of sac thin.

The aneurism was egg-shaped, the larger end downward, and a little inward, measuring five inches in length, three and three quarters in depth, and extended from about one inch from the origin of the external iliac artery, which was enlarged to within one and a half inches of the profunda covering the external iliac vein for about two inches of its course externally and posteriorly. The tumour, on being laid open for the entire of its extent, contained at its two superior thirds a very soft greyish fibrin

« AnteriorContinuar »