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the night. On the following day, being very busy, and the labour having made no progress, he left her in charge of the midwife who was in attendance upon her. The pains were lingering, but not very severe. On the third day, she felt something " drop down suddenly inside her; and the child, the movements of which she had constantly felt up to that time, at once became cold as a stone." She was in great pain, and my father had attended her for a considerable period. She refused to allow
a any surgeon or physician to attend her, or to have any operation performed. She gradually improved in health, although she was very weak for a long time, and did not decrease in size for several years.
Upon examination, I found her much emaciated, with a hard bony tumour in the lower part of the abdomen, exactly resembling the fætal head. It could be easily moved from side to side ; and, on careful manipulation, I believed that I felt the back part of the thorax in close approximation to it. She was evidently sinking from chronic renal disease; and, knowing that her end was approaching, had sent for me to request that I would make a post mortem examination. She had previously made a similar request to Mr. William Knott.
The story was corroborated by some of her neighbours, and by the rector of the parish, who had heard from my father a full report of the case. It was also stated, that at different times three little bones,“ like finger-bones,” had come away from her; but they had not been preserved.
On referring to old ledgers, I found the entry of the attendance on October 8th, 1822, in the handwriting of my grandfather, with the subsequent payment of the fee marked in my father's handwriting, and with his initials.
The woman died on January 13th, and the examination was made on the 15th by Mr. William Knott, in the presence of Mr. Knott, sen., Mr. Garlike, and myself. On making an incision through the abdominal parietes and opening the peritoneum, we immediately observed a hard white substanc, which proved to be the vertex or fætal skull; and on enlarging the opening, a perfect foetus was extracted without difficulty. It was covered with plastic lymph; the limbs were flered anteriorly on the body, and the head bent forwards to meet them, in the manner usually depicted in plates of the gravid uteras. It was attached by the umbilical cord to a vascular tumour of about the size of half an orange, which appeared to be the atrophied placenta, and which was connected by ligamentous attachment to the peritoneal covering of the broad ligament near the left ovary. One portion of this vascular tumour appeared to be a mass of unorganised lymph containing fluid. Neither
the fætus nor the supposed placenta had any adhesions to to the peritoneum, except the ligamentous attachment I have already mentioned. The uterus was perfectly normal. There was no cicatrix or other marks of injury on any portion of its surface. The ovaries were pale, but quite natural in size and form. There were no adhesions of the peritoneum in any portion of the abdominal cavity, and no appearance of previous inflammatory action in any part of the large or small intestines. The kidneys were extensively gorged with venous blood, and very friable; the left being more affected than the right. The spleen also was much congested and friable. The stomach and liver were healthy. The gallbladder contained about twenty hard dark gall-stones. The pancreas was very much diminished in size. In front of the aorta, and immediately above the inferior mesenteric artery, to which it was connected by condensed cellular tissue, was a white encysted tumour, of about the size of a hen's egg, containing a milky fluid.
The above extraordinary case is, so far as I am aware, quite unique, and will be interesting, not only as an instance of recovery from tubular gestation and probably rupture, but also from the comparatively slight local and constitutional effects of a foreign body retained in the cavity of the peritoneum for more than forty-three years. The specimens have been forwarded to Dr. Barnes, for exhibition at the meeting of the Obstetrical Society.-British Medical Journal.
CYCLE OF DISEASE. Doctors have been writing a good deal lately about “change of type in disease.” Some of them, indeed, adopting a recent “heresy," have said there is no such thing, the change being solely in their modes of treatment, not at all in the constitution of their patients. Dr. F. J. Brown, of Dorchester, however, brings forward a startling fact. Formerly, he says, the peasants round him used to be bled once or twice a year, losing 16 ounces, and walking home many miles without inconvenience. Of late years the same men and their sons have fainted from the loss of from four to eight ounces, and so the practice has been dropped. Dr. Brown,
, who seems to have been a very careful observer, thinks that change of type, like so many other things, is periodic. Since the spring of 1864, he says, the plethoric type is gaining upon the nervous ; men can lose blood with benefit now who could not do so a few years since.” The nervous type, he asserts, came in with the first cholera epidemic, and has lasted about the third of a century. This is encouraging. If the nervous type goes, we may hope that cholera will go along with it. But the whole question of cycles of disease can scarcely yet be handled scientifically.—Pall-Mall Gazette.
Canada Medical Journal.
MONTREAL, APRIL, 1866.
There are certain forms of disease which are well known to be the result of a specific poison entering the blood. Of these, we may mention the various forms of fever ; in fact, that class of disease known as of zymotic origin. Among this class is to be mentioned cholera, the question of the contagious and non-contagious nature of which is attracting considerable attention at the present day throughout the scientific world.
This question has divided the profession into two schools—those who assert that disease of the zymotio class is produced by special poisons independent of condition, and capable of being generated and reproduced from one individual to another. Another class of sanitary reformers there are who regard zymotic disease as being caused alone by neglect of certain sanitary laws, and from emanations from decomposing animal or vegetable refuse. Much injury is done by extreme views of either party, while the advocates of measures calculated to embarrass trade such as rigid quarantine regulations on the one hand, and those who regard disease as occasioned alone by neglect of common cleanliness on the other, are each clamouring for the adoption of their specific views. It would be well to consider the advisability of adopting, as a whole, common sense views of the obligations imposed on each individual for his own safety, and that of the whole community. That cholera is contagious in the same nature as is small-pox, typhus fever, or other zymotic diseases of this class, we do not believe; it is a question, however, which is far from being settled definitely. There is much to be said in farour of contagion, and much against it. There are certain conditions which, of necessity, must exist prior to the development of any contagious disease : firstly, we must have the poison capable of developing the disease ; secondly, a medium of communicating the poison ; and, thirdly, an individual predisposed to receive it. That cholera is produced by a specific poison seems to be the generally received opinion ; that the
poison of cholera is developed or propagated by defective drainage and uncleanliness of localities, appears to be unquestionable; and that individuals are rendered more liable to its attack by neglect of personal sanitary measures of whatever kind, be it of personal cleanliness, scanty or unwholesome food, intemperance or loose living, is to our mind conclusive. With regard to the medium of communicating the cholera poison, this is a question which is far from being satisfactorily settled. One theory is that water is the medium of communication, hence the theorists assert that the disease invariably follows the course of navigation; but unfortunately for them, it generally goes up stream. Cho tra in 1832 appeared in Quebec early in the month of June, and almost simultaneously, we believe it was a few hours after—it broke out in the Barracks in Montreal. No personal communication had occurred between the two cities. In 1834 it appeared in Quebec, Montreal, and Toronto on the same day; and on the Upper Ottawa a case is mentioned of a party of raftsmen bringing their timber to market, who had not held communication with any civilized community for months, but who were attacked with a violent purging and vomiting, and three of their number died in a few hours. This last circumstance we have heard from several men connected with the lumber trade, and can be authenticated.. A somewhat similar case is on record. In November, 1848, two vessels left the port of Havre bound for America, one the Swanton, on the passage to New Orleans; the other, the ship New York, bound for the port of that name. While in mid-ocean the cholera broke out on board of each vessel, and proved fatal in from twenty to thirty individuals in each ship. The port of Havre at the time the vessels left, was entirely free from the disease, nor had any of the crew or passengers been in the vicinity of the disease before embarkation. These circumstances would almost point to the atmosphere being the medium of communication of the cholera poison; certain local conditions, as low marshy or ill-drained land being favourable to the development of the disease.
General sanitary precautions should be adopted by communities, and the cleaning of streets is a necessity which should be rigidly enforced. All house refuse should be removed without delay; vegetable or animal matter should not be allowed to remain in heaps until a sufficient quantity accumulates to form a load, but should be removed each morning.' A proper system of scavenger carts ought to be introduced. All marshy lots—and there are many in the lower parts of this city—should be efficiently drained, as there can be no doubt that the moist atmosphere, which is found near such situations, is highly favourable if not to the development, at least to the propagation of cholera. These are a few suggestions, which we trust will
be acted on in time to be of service to the community. There are other duties more of a personal character which deserve mention. House cleanliness, frequent ventilation, and the free use of lime ought to be insisted on; the police should have the power under instruction of the Health Officer of enforcing sanitary measures under penalty.
But while we are attending to the condition of our houses and thoroughfares, let us not omit personal sanitary precautions.
Intemperance both in eating and drinking should be avoided at all times, but more especially during the existence of epidemic disease. The daily use of spirituous liquors is unnecessary if not positively injurious, and especially so with the thermometer ranging between 90 and 100 degrees in the shade. We advise no sudden change in the habits of life, but would especially enjoin temperance and abstemiousness in all things.
The diet should be plain, nutritious and easily digestible-unripe vegetables and fruit should be avoided; in a word, let each individual live —as far as his diet is concerned-in that manner which he has found most conducive to his health.
Severe mental or bodily fatigue is highly injurious, inasmuch as considerable waste of nervous power is the consequence, and hence the system is rendered more liable to an attack of any prevailing malady. The necessity of personal cleanliness cannot be too urgently recommended. The clothing should be comfortable, seasonable; let each individual watch the changes which occasionally occur with such rapidity, and if need be change his clothes to suit the temperature. Nothing can be more injurious than the sudden arrest of free action of the surface, by exposure, without sufficient or adequate clothing during the sudden vicissitudes of our ever changeable climate. Such are the measures we would recommend for general adoption. The object being to preserve the body in a state of as perfect health as possible, avoiding excesses of all kinds and abstaining from anything likely to derange or impair the digestive functions.
Our readers will receive with this number of the journal a circular from Dr. Hingston, to which answers are requested. The same circular has been sent to the French Canadian Physicians through the Gazette Medicale, and in these ways a fair expression of the views entertained by the profession generally, is expected. We are in a position to state that should the answers indicate a more than usual acquaintance with the subjects contained in the questions, Dr. Hingston will give them espression, and the writers due credit. As the questions are of interest to the profession generally, we hope the circular will receive immediate attention.