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then proposed the administration of a mixture of infusion of mint with æther, and applied compresses, dipped in æther, to the tumour. Soon after this práctice was tried, the pain in the abdomen, the hiccup, and the vomiting, subsiderl; the swelling sensibly diminished, and by the next day totally disappeared ;since which the patient has had no return of the complaint.
To the Editors of the Medical and Physical Journal. . GENTLEMEN, As nothing tends more towards the elucidation of medical science than the records of cases and facts, and as I do not immediately recollect having any where read of a case of twin births similar to the one I have here detailed, or met with during a period of thirty years, I send it for insertion in your useful Journal.
Ann Binder, a young woman about sixteen, being in her first pregnancy, was taken in labour on Sunday'afternoon, the 24th of July, 1609. She was attended by a very experienced midwife, but not being able to accomplish the delivery, she sent for me about seven o'clock; when I arrived, she informed me it was a twin case, and the first had presented by the feet. On passing an examination, I discovered that the body of tbe child had protruded through the external orifice, with the arms down on each side; the funis umbilicalis, extremities, and part of the parieties of the abdomen, were in a state of putrefaction ; therefore I concluded this child, for some considerable time, bad lost its existence; the abdomen was towards the pubis of the patient, and was so completely pinioned or impacted in this way, in the external orifice, which was very contracted and rigid, that it was not without some considerable time and trouble I could extract the shoulders ; 'and with much difficulty, with all the care, attention, and circumspection possible, prevented a laceration of the perinæum. I'naturally concluded that when tbe shoulders were cleared through the os externum, the bead would have immediately followed; but still finding a very great obstacle in its descent, and fearing if too much force were applied, I might have separated the head from the body; and well knowing what 'must follow in such a case, that it must have been left in the cavity of the uterus, bad it been so separated, and must have been extracted after the
birth of the second, as in embryotomy, with the long scissars and crotchet; and as it occurred, from the child being some time in a putrefactive state, the neck was in part dislocated with the little exertion I bad used on this occasion, I desisted from any further attempts, till I was fully convinced of the cause that impeded the delivery. On passing another examination, I found the head of the second child had passed that of the first, into the inferior aperture of the pelvis, with the vertex towards the pubis, and the face towards the sacrum, the head of the first still resting on the symphisis of the ossa pubis; in such a situation, as there was no deficiency of uterine action, or want of labour pains throughout the whole process, I suffered the labour to proceed as in cases where there are only one, and about nine o'clock in the evening she was delivered of the second. After the labour bad been so far concluded, the head of the first passed downwards with only a single pain, and was protruded through the external orifice so rapidly, and with so much violence against my left hand, that I could scarcely maintain it to support the perinæum again from laceration. · The united placenta were afterwards extracted in the usual way about twenty minutes or half an hour afterwards, al. though the funis unbilicalis of the first had been worn through nearly towards its insertion in the parenchymatous substance of the placenta, in the head of the second passing through the external orifice. They were twin girls, and both born dead; the patient recovered from the parturient state in less than three weeks.
From the concurring circumstances in the above recited case, it would naturally appear that the length of time which had elapsed in endeavouring to extract the body and shoul. der of the first child, gave the second the opportunity of descending down and passing that of the first into the lower aperture of the pelvis, and from there being no laxity of uterine action pressing on its contents, quaque versa, there was no possibility of returning the head of the second above the superior aperture of the pelvis, could it have been wished for, but was obliged to submit to the evil then existing, rather than incur the risk of doing far greater mischief to the patient by injuring the soft parts, or what woald have been still worse, possibly of rupturing the uterus, or of leaving the head bebind, either of which every prudent and cautious accoucheur would rather endeavour to avoid.
Another remarkable circumstance attending this case was, that, in addition to the head of the second child pressing upon the perinæum, expecting on the return of every pain its momentary exit, the neck of the first being so completely
Fatal Effects of eating Cherries, and copious Bleeding. SI wedged in the os externum, there should be no laceration of the perinæum.
I am, Gentlemen, your's, &c.
· H. G. CLOUGH, M. D. 18th Nov. 1810.
To the Editors of the Medical and Physical Journal.
having red with n of attendiet
M Y son, who studied physic at Philadelphia in America, relates the following case, which occurred whilst he was at. tending the hospital in that city,
" The porter belonging to the Hospital (Philadelphia) having eaten excessively of cherries, which abound there, was seized with violent vomiting and convulsions. It was Dr. Rush's month of attending. The House Surgeon bled the man freely without relief; in the evening he was bled again, copiously, in both feet : the next day the arteries in both wrists were opened ad deliquium, without relief, the convulsions continuing. The day after, both arteries in the ancles were opened ad deliquium. The following morning, being the fourth day from the attack, he expired in convulsions."
My son makes the following observations. If the patient, as he vomited up the cherries, had taken plentifully of warm water or camomile tea, to have emptied his stomach, as nature dictated an emetic, and then a purging mixture, or enema, it is my opinion that his life might have been saved.
A gentleman in very extensive practice, in a hurry, opened an abscess in the throat with a lancet which he had used for inoculation. The child a few days afterwards was seized with a putrid fever. I saw the child; it was about two years old. The part that was opened had hundreds of the confluent small-pox; no other part of the body, excepting the place where the abscess was opened, was affected. The child expired covered with purple petechiæ in a very few days. The gentleman aflirips, that the lancet had been well scalded in boiling hot water before he used it.
I am yours, &c. Thornbury, Gloucestershire, J. E. HARRISON, M. D.
Nov, 26, 1810.
Note. Dr. Harrison requests us to correct an omission in his Case of Cancer, in the Journal for October 1810, p. 276, line 6, where instead of advising the patient to trust, it should have been written advising her to trust in God." And in the case of Flyer Albus, p. 279, for discharge remaining, read No discharge remaining.
To the Editors of the Medical and Physical Journal. "
Mr. Earl's Intention of an Aneurismal Needle. . GENTLEMEN, In some Surgical observations which have been lately published by Mr. Ramsden, under the head of " Cases of Aneurism with practical Remarks,” will be found a description of two needles; the first is said to be the invention of Mr. l. I. Watt, the second of Mr. Alenry Earle. In referring to the plates, the reader will no doubt be much surprised and disappointed to find, nearly the same instrument described as the invention of two different people. It must naturally strike him that the second has been borrowed from the first without any acknowledgment on the part of its pretended author. It is to remove any such impression, which cannot fail of being înjurious to my reputation, that I beg the admission of these lines into your widely circulating Journal. The real fact will be found to be, that they were both invented at the same time, and both by me, as I trust I shall prove in a most satisfactory manner.
The circumstances which gave rise to their invention were as follow." "A case of axillary aneurism occurred in St. Bartholomew's Hospital, in which Mr. Ramsden took up the subclavian artery just after it emerges from behind the anterior scalenus muscle; the aneurismal tumour was very large, and had elevated the clavicle considerably higher than na. tural. The artery was found without any difficulty, but the operation was nearlyfoiled at a point wliich was little expected. In consequence of the clavicle being pushed up, and the depth of the wound, it was found impossible to pass a ligature mund the artery, notwithstanding Mr. Ramsden had prepared himself with a great variety of needles. Though these were different in shape, they were similar in principle, and that unfortunately was imperfect. I cannot forbear here red marking, that it is to be lamented that Surgeons do not pay more attention to this mechanical part of their profession> the fabrication and invention of instruments is left almost entirely to artists, who must be ignorant of the object to be attained; their instruments appear very eligible in theory, but when submitted to the test of experiment they will too often be found insufficient and useless.
For above an hour and half, all attempts to pass a ligature were, ineffectual, though needles were several times passed under the artery so as to appear on the opposite side; further they could not pass, it being impossible to depress the handle in order to raise the point, Another fault which ibose needles
bad, was the length of the eye, whereby the ligature remained on one side of the artery when the point was on the other. At length I handled to Mr. Rimsden part of the stilet of a flexible metallic catheter, which'I had flattened for the purpose. This rude instruinent, from its great pliability, passed readily under the artery and was drawn up on the opposite side, a ligature was then fastened to it, and the operation happily concluded.
During all this time I was close to the patient, and had an opportunity of observing the cause of embarrassment and the means whereby it might be removed. That night I sketched, the instruments which have been described by Mr. R. and the following morning directed them to be made by Mr. M Lellan, an ingenious instrument maker at St. Bartholomew's. The first that was completed consisted of a fat silver cannula slightly curved at its lower extremity, with two small wings at its upper, at the back there was a groove for the ligature to lie in. In this cannulą was fitted a spring about an inch and half longer than it, at the upper extremity, of which there was a small handle, at the lower an eye for the ligature. When this instrument is to be used, it most be armed with a ligature which is to be placed in the groove and attached to the wings at the top, the spring being drawn within the cannula. It is then to be passed under the edge of the artery, the ligature loosed and the handle depressed, when the spring, from its elasticity, will rise on the opposite side, carrying with it the ligature, which must be detached and the spring drawn within the cannula, or the necdle may be threaded after it has passed under the artery.
This instrument I shewed to Mr. Ramsden, and at his request gave him the preceding account. I also showed it to Mr. Astley Cooper, who received it with the liberality and zeal with which he never fails to embrace any thing that is likely to improve the Profession. On trying this needle on the dead subject I found that the spring in its passage formed too large a circle, whereby the neighbouring nerves were endangered. I recurred, therefore, to my original plan, and ordered a needle of soft metal about an inch and half long to be made to fit the cannula, into the upper part of which was fitted a flat steel spring of the same length as the cannula, having a handle at the top, which when depressed would push out the needle with its ligature. In short, I ordered the precise needle which has been described as Mr. Watts, contrivance. This instrument I showed to Mr. Ramsden and several other gentlemen, and it was publicly sold at M.Lel. lan's as my invention. In the mean time Mr. Watt invented a needle which was made at the same shop, the object of which was the same as mine, though the means were ma(No, 243.)