of ventral, or even in compound cases of hernia; as it may be adapted to any part of the abdomen. Mr. Hey has given a description of its construction in the second edition of his Practical Observations in Surgery, p. 577. And in the Preface to the above valuable work, the author has spoken in high terms of Mr. Eagland's machines for supporting the spine, and the extremities of the body, in various deformities. To the Editors of the Medical and Physical Journal. GENTLEMEN, THE following singular case of twins having lately`oc curred in this neighbourhood, I am induced to request you will insert it in your highly useful periodical work, that others may have an opportunity to pass their opinion on a case, which I consider of the highest practical importance. A woman between thirty and forty years of age, and rather corpulent, was delivered on Sunday, the 10th of February; nothing particular occurred during her labour, except that the child was smaller than common. The accoucheur, probably from the rare occurrence of twins, did not examine sufficiently to discover another foetus. On the Friday following, the woman declared to him that she still felt the motion of a child; in consequence of which he examined per vaginam, and could distinctly feel the head of a foetus situated very high in utero. The os uteri was contracted to about the size of half-a-crown. The Sunday following he requested me to see his patient. On applying my hand upon the abdomen I was immediately convinced of the existence of another child; the motion of which I felt distinctly. The woman having continued as well as could be expected since her former delivery, I gave my opinion, decidedly, to wait patiently, leave the result to nature, and cautiously to observe her operations, which perfectly coincided with the sentiments of the practitioner employed. On Sunday, the 24th of February, a fortnight from the birth of her first child, labour recommenced, and she was soon delivered of a fine boy, much larger than the former. The mother is doing perfectly well, not having felt any unfavourable symptoms since the commencement of her confinement. Her milk did not appear till two days after the birth of the second child. From the circumstance of the above case terminating so favourably, and having heard of other similar cases, particularly one, in which six weeks had elapsed, and another, a fortnight a fortnight between the birth of each child; 1 am almost inclined to pay some deference to the rejected doctrine of superfœtation; or at least, to doubt the propriety of the present established practice, to deliver per artem, if nature is tardy in her efforts to expel the second child. Most of the public teachers of the present day are not, in my opinion, sufficiently explicit in their directions for the management of cases similar to the one I have related; namely, where the placenta are separate in the uterus, and each follows the body to which it belongs. Dr. Hamilton certainly gives directions rather more fully: he says, "the placenta of twins are often distinct from each other in the uterus, and so loosely connected to it, that one may entirely separate before the second child be born, so that labour pains will sometimes cease for two or three days, and there is the same interval between the birth of the children." A little further, he says, 66 in this interval the patient is apt to suffer from impatience, and anxiety, floodings frequently come on and the labour is more painful and bazardous, in proportion as the time of delivery is protracted." It is with the utmost deference that I differ from such high authority; but I would ask you and other professional gentlemen, if we are not justified in drawing the following inference from the cases I have mentioned; that it would be more prudent, if no unfavourable symptoms occur, to leave the expulsion of the second child to nature, rather than to interfere according to the present practice; the objection that there is danger from hæmorrhage ensuing, in my opinion, principally exists where the placenta have been at all connected; and that if they are perfectly distinct, there is little more risk from that cause than in common natural labour; as I conceive that the uterus would be so much relieved from the expulsion of one child, as to be able to contract sufficiently to guard against such an accident; but even should hæmorrhage be the consequence, yet, would it not occur soon after delivery of the first child? and consequently would sufficiently justify the interference of art. I am much inclined to suppose, that instead of the hazard being increased in proportion as the time of delivery is protracted, as Dr. Hamilton asserts, it is considerably diminished; at least, such an inference I think we are justified in drawing from the case I have related. Guisbro' Yorkshire, March 8, 1811. I am Gentlemen, JOHN JONES,* Member of the Royal College of Surgeons, London. *We hope in a future number, probably the next, to give the opi To the Editors of the Medical and Physical Journal. GENTLEMEN, DURING the present arduous contest for the vacancy in St. Luke's hospital, occasioned by the resignation of Dr. Simmons, I have heard much of the necessity that a physician who undertakes the important charge of the patients in that hospital, should be practically conversant with the treatment of insanity in particular. I admit that in some respects this would be an advantage, but I cannot regard it as an essential one. I ask, is there any one regularly educated physician, accustomed to see and to treat diseases in general, who, if suddenly called for the first time to attend an insane patient, would be so ignorant of the nature of mental derangement, as to be at a loss how to act? I confess that were such a practitioner pointed out to me, I should pronounce him unfit to pursue a profession which demands a knowledge of every variety of disease. The popular cry is in favour of practitioners devoting their attention to one disease in particular, and so well has this been seconded by interested individuals, that the physician is now excluded from treating many com nion and observations of a London professor, on this interesting subject. At present we are disposed to adopt, as a general principle, the practice recommended by our ingenious correspondent, liable, however, to exceptions and limitations, arising from the peculiarities of individual cases. If a second child is discovered in the uterus immediately on the 'delivery of the first, enveloped in its proper membranes, and having a distinct placenta, even if no hæmorrhage to a dangerous degree exist, and there be a total absence of uterine action, it may be a question, if in this open and practicable state of the parts it be proper to rupture the membranes of the second child, and deliver immediately. But if so much time has elapsed before the second child is discovered as shall have given the uterus leisure to contract; and if the os uteri, as in Mr. Jones's case, has diminished to the size of a half-crown, there existing neither dangerous hæmorrhage or other alarming symptom, what reason can be urged for proceeding to immediate delivery per artem? The anxiety and solicitude that the mother will feel from the lingering prospect of a second delivery, and the labour becoming more painful and hazardous in proportion as it is protracted, according to Prof. Hamilton, do present some motive, under the most favourable existing cir cumstances, for immediate delivery of the second child. Will it be difficult to decide between this remote hazard, and the direct danger arising from a manual dilatation of the os uteri; an operation, which if not only, is best justified by the existence of an hæmorrhage that puts the patient's life in danger? The present rational state of the ars ob stetrica, and the high degree of science manifested by its professors, cannot suffer this question long to remain in doubt. EDITOR. S (No. 146.) plaints plaints that formerly were in his immediate province. Thus he has lost all influence over complaints of the eye and the ear; he is not suffered to treat any of the various forms which syphilis assumes; scrofula is no longer under his control; it is now the fashion to consign the diseases of women and children to the diplomatized accoucheur, and whilst the physician very properly refrains from interfering with the chirurgical department, he hears of chaste surgeons treating continued fever, pulmonary consumption, and, in short, any other general disorder to which the frame is incident; and their prescriptions too ratified with their signatures. Without wishing to excite insidious jealousy between the two branches of the profession; I would call the attention of the readers of your Journal to this rapidly growing stricture of the physician's practice in London. Besides the undue and unprofessional encroachment of the surgeon on the function of the physi cian, he is elbowed out of practice by the apothecary, who in turn is shuffled off by the druggist. Gentlemen, that acute observer, Dr. Beddoes, remarked, that the time was approaching when there would be fewer physicians, meaning that the public would become too enlightened to require so much of their aid; I think that the time has arrived when, for their own interests, there ought to be fewer. So far from this diminution being effected by the superior wisdom of the public, it would seem to be accomplished by its folly; a more expensive, and at the same time a more inferior and dangerous species of medical assistance being substituted for that afforded by the regular physician, who is now in very many instances the last person, except the undertaker, thought of to be introduced into the sick man's chamber. At what period in the annals of medicine has quackery been more triumphant? when have the chariots of illiterate pretenders to the art more abounded, or when have there been a greater number of deserving physicians unemployed? Is this then a time to encourage the belief that a regular physician is not to be entrusted with the treatment of insane persons, as well as with that of any other patient affected with general disease? Unfortunately the malady is usually so little under the influence of medicine, that the keepers have much more to do with the patient than the physician has; and I am at a loss to comprehend how evacuants will operate more effectually when directed by a mad doctor, than when prescribed by an ordinary physician; nay, I will venture to assert, that in many instances there is danger of establishing a disease from the dread inspired by a mad doctor, which would not have occurred had a common practitioner been consulted. By avoiding restraint and using soothing means, we sometimes avert the threatening malady. "The the shrewd doctor, in the spleen-struck mind The patient to those manly sports, which bind In the hopes that some more able correspondent will pursue this interesting subject, I am, Gentlemen, Your's, &c. CENSOR. London, March 4, 1811. To the Editors of the Medical and Physical Journal. GENTLEMEN, I MET with the following Recipe for the preparation of James's Powder among some medical Extracts belonging to my late father; it had been in his possession near forty years. As it bears a great resemblance to the able analysis of James's Powder by Mons. Pully, in the Annales de Chimie, and inserted in the 8th volume of the Repertory of Arts, you will oblige me by inserting this along with the enclosed Recipe. R. Reguli antimon.* sal. nitri. ana ponder. æqual. separatim in pulverem trita probe misceantur, deinde gradatim injiciatur mixtura in crucibulum; materiam ab igne remotam aqua bulliente ablua, et pulverem subtilissimum tere. R. Pulv. ut sup. ǝss. ad ǝj. mercur. D. 6ta. sublim. gr. 1 M. ft. pulv. Y Perhaps no preparation in the whole range of pharmacy has given rise to more discussion than the preparation of this active mineral, yet we are still scarcely agreed as to the best mode of preparing it, or even as to its composition, and after all, perhaps, the method of oxydating antimony by the heating it in contact with nitre, though less free from impurities, may be considered as producing an oxyd, in which the extraneous matter is less important with respect to its employment in pharmacy. Your's, A. B. * Vid. regulus antimon. James's Dispensatory and his succeeding Note. |