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given, without overcoming the stricture. I ought to have stated that in this last attack the evacuations by the mouth had still more decidedly the odor and color of fluid faces, and that all the injections were retained. About the third or fourth day from the attack, something was discharged by the anus which the attendants confidently stated to be a worm, but which, when I saw it, had more the appearance of a portion of membranous substance, broken down and almost dissolved: It came away unaccompanied by feces, and the constipation was not affected by its discharge.
Finding the effects of the tobacco clyster to be as above stated, I judged it prudent to discontinue its use, and ordered the following medicines to be continued: R. Mist. x\ssafcetid.
Aqua; font. aa. ?iv.
Tinct. Opii, gij.
f. Enema Secunda quaque hora inj'iciend.
Sumat statim Hydrargyri, ijiv.
Mitte Ol. Ricini, gij. quo infricetur abdomen sa:pe. Four of the above injections were administered, and the quicksilver given the same night, after which the patient lay in a state almost of insensibility for about twenty-four hours, and the attendants were about to give him eight ounces more of quicksilver which I had ordered to be in readiness, when he unexpectedly expressed an inclination to stool, had a copious evacuation, and from that moment again gradually recovered. I did not see him again till yesterday, when 1 found him walking about his farm-yard. His bowels are now regular, but he is still very weak, and his legs have become ccdematously swollen..
In reflecting upon the peculiarities of the above case, the following questions suggest themselves. What was the state of the intestines upon which depended the constipation? Was it an inverted action of the whole course of the canal; was it constriction from inflammation; or was it a case of intus-ceptio? Aud in regard to the remedies, we are led to inquire what share the opium had in the cure, and how much might be attributed to the operation of the crude mercury?
The pain which was felt in the first instance would lead to the supposition of local inflammatory action, while the retention of the clysters, and the faecal vomiting, favor the conclusion of inverted action, which, by the way, when we reflect on the structure of the intestines, and especially the value of the colon, is not very conceivable. In regard to the share which the respective medicines had in the cure, I must repeat my conviction of the great benefit derived from
3 L 2 . the the opium, which, although less unequivocally and immediately operative in the second than in the first attack, still, in this last, I think, to say the least of it, preserved life, while the quicksilver or vires naturte effected the restoration of due action in the howels. It becomes a question how far the mercury operated at all, as there was no evacuation until the Thursday afternoon after it had been given on the Tuesday night.*
But I must conclude,—my intention was to publish facts, and not to propose theories; and I will no longer draw upon the pages of the Journal, or patience of its readers. Aylesbury, Bucks, DAVID UWINS, M.D.
Sept. 15, J 813. N
To the Editor of the Medical and Physical Journal.
SEEING a case of " Rupture of the Uterus during Labour"
Oct. Uth, 1813. CHARLES MAYO.
Thursday, 17th of June last, I was called to Rachel Marsh, at five in the morning, and found that her water had broke, about an hour before, which waked her from a sound sleep. This, however, was succeeded by no pain, and therefore, after remaining with her a short time, I left her, desiring to be sent for when her pains commenced. I saw her again in the course of the day, but found that no pain of consequence had occurred, the water still continuing to come mvay. On Saturday I called again; she continued much the same, had had occasional pains, but passed her nights pretty quietly. On Monday morning I again saw her: the pains had been more frequent and severe, much water had drained from her, and early this morning a quantity of very foetid and discolored discharge had come away. She felt great pain in the left inguinal region, and had experienced more or less in that situation throughout her pregnancy. In the evening, about nine, I was sent for in great haste, with intelligence that her labour-pains had now come on with great severity, and that the nurse expected
* The attendants neglected to examine the faeces first discharged from the taking of the quicksilver.
the the birth of the child very speedily. On my arrival, she was walking about, and several sharp pains came on soon after. I found the os uteri dilated to about the size of a crown piece, and very little below the brim of the pelvis, the head presenting. She was extremely restless, and would neither lay, stand, or sit, for a moment. After I had been with .her a quarter of an hour, a sort of convulsive fit succeeded one of her pains; and I understood she had been subject to fits in her former labours. She was very short, and extremely corpulent, which, added to her pregnancy, rendered her very unwieldy, and, from her great restlessness, almost unmanageable. She continually exclaimed she should die, and begged that more assistance might be sent for. She had been attended by two other gentlemen in her former labours, and I requested that one of these might be fetched. In the mean time, as she sat, a pain came on, which was succeeded by a considerable rigor, and she became faint. Presently, on her rising from the seat, I perceived on the floor a quantity of blood. I immediately got her on the bed to examine: I found the os uteri much more dilated, but the head had made but little progress in its descent, and there was no haemorrhage perceptible. As she laid down, she repeatedly said, I am going, and prayed for her children, as if she was sensible of her approaching end, which, from the frequency of these exclamations in the time of labour, no one had as yet regarded in a serious light; but now indeed both myself and her attendants began to be alarmed, when her extremities became cold, and she uttered a deep groan, and scarce five minutes had elapsed since she laid down, before she expired. The gentleman who had been sent for arrived soon after: he suggested a variety of accidents which might have been the causes of this event, and which we determined, if possible, to ascertain by dissection the succeeding day.
On dividing the parietes of the abdomen, a quantity of fluid tinged with blood escaped. The uterus occupied its natural situation, and at first sight appeared sound, but on raising the fundus, a large black echymosed patch was observed on the left and posterior part of the neck; here a limb of the child was felt to protrude, covered only by what appeared to be the peritoneal coat of the uterus, but so loaded with blood as not to enable us distinctly to ascertain. Without disturbing this, I laid open the anterior part of the uterus; the head of the child plugged up the superior aperture of the pelvis, and was descending in the natural way, and this we did not withdraw, in order to prevent the escape of the fluids with which we were now encumbered. We
discovered. discovered a distinct laceration in the inside of the uterus, at the place before mentioned, and the elbow and shoulder of the child were entangled in the opening. The supposed membranous covering easily gave way, and the naked arm was readily drawn through the fissure. With regard to the nature of this aperture, whether it was the effect of a momentary cause, or whether the result of long preceding disease, the opinions of several surgeons present differed. The edge of the opening, which was a sort of longitudinal slit about four or five inches in extent, appeared smooth and defined on one side; but being called away suddenly, neither time nor convenience would suffer me to make a more accurate investigation. No one doubted that this must have been the cause of her death. There had been no hemorrhage of importance, but we were inclined to think the structure of the uterus somewhat depraved.
She had been the mother of ten children, which she had borne very quicklj-. I learnt from the gentlemen who had formerly attended her, and who were present at the examination, that she was always of that restless disposition during her labours. The early rupture of the memhranes was probably in this case very prejudicial -, and it has occurred to me to observe in several cases which have been related, that the subjects of them have been very corpulent, and have borne many children. From these causes, I conceive the muscular structure of the parietes of the abdomen frequently becomes very much debilitated, so as to diminish, and almost abolish its contractile power, and consequently deprive the uterus of a very powerful assistant during labour. The linea alba in this case was very wide, and the recti muscles pale and thin, spreading on each side to a great extent.
To the Editor of the Medical and Physical Journal.
THE insertion of the following observations connected with the relation of a case in your valuable miscellany, will oblige the author.
In some former Numbers of your Journal, I have more than once attempted to point out, by the result of fortunate cases and analogous reasoning, the practicability of curing diseases, particularly those of an inflammatory kind, by inducing a new action into the system, and thus superseding the morbid one previously existing. I am well aware that the exhibition of mercury in these diseases is not a novel
mode of treatment, nor the principle I have just noticed unknown; for the axiom on which the rationality, and, as far as my limited experience extends, the practicability of this plan of treatment rests, was laid down many years ago by the celebrated Mr. John Hunter, whose idea was that it was incompatible with the laws of the animal economy to support two actions in one system at one and the same time; but though I disclaim any merit as to the discovery of this great pathological axiom, I hare endeavored, with some perseverance, for several years past, to build a practice on the knowledge of it, the striking advantages attending which have been most conspicuously apparent in a number of instances, some cases of which I have related in this Journal; and in other cases of equal success, I have solicited the attention of my professional friends to witness the success resulting from this mode of treatment. Mercury is frequently administered by medical men, yet the principle on which I conceive it to act is not generally admitted. That principle may be erroneous, but 1 much wish to excite professional men to a candid inquiry of the subject, as I do entertain an opinion that it has prepondency of evidence on its side. This induces me to offer some further observations on the subject, as I conceive it is upon a knowledge of this principle alone that an extended and general adoption of this practice will ensue.
Ii is my idea that the benefits resulting from the exhibition. of mercury into the system in cases of deranged morbid action, particularly of an inflammatory kind, are solely attributable to the production of a new action; and that a decided and perfect remission of symptoms never takes place till the action is perfectly established; and that the system, unable to attend to the diversified operations of two actions existing at one time, the morbid one is forsaken in order to attend to the formation of secretions which the new action requires, in order to maintain its existence in the system. Under this impression of the principle on which this remedy acts, it is conclusive that the mineral ought never to be discontinued, till-it is evident that a new action is perfectly formed, which is evinced by a ptyalism being produced; proving that the powers of nature are all put under requisition to support and maintain for a certain period the continuance of a new. and inordinate action.
In cases then of a morbid inflammatory action, such as.' hepatitis, enteritis, gastritis, inflammatory rheumatism, incipient stage of phthisis pulmonalis, and diseases of a similar nature, the practice of administering mercury, and stopping any thing short of this effect being produced, is inert an&