Swallowing, on the use of the epiglottis in 203 obftructed pharynx in U 442 W Teftes, cafe of idiopathic inflammation of Walker, Dr. in reply to Mr. Chapman 353 209 letter to G. Rofe, efq. 282 381 60, 139 345 Trial, legal, for unfkilful surgery 27 Tubercular eruption of a fyphilitic appear- ance, cafe of 141 Tumour in the neck successfully removed loins 66 's Mr. cafe of fractured femur 237 Ware's, Mr. paper on mufcæ volitantes 143 60 Water doctor, humorous portrait of a 257 95 56 testines Vagina, imperforated, case of Veficatory, convenient formula for Volcano, air, account of an of Jorullo, account of Y 262 Yeaft, on the employment of, in fever 173 491 438 Yellow fever, cursory obfervations on 113 PRINTED BY W. THORNE, RED LION COURT, FLEET STREET. NEW Medical and Physical VOL IX.] JUNE, 1815. [NO. 56. To the Editors of the New Medical and Physical Journal. GENTLEMEN, THE fatal case of Uterine Hæmorrhage, so candidly related by your Correspondent in November last, p. 359, deserves attention, as he appears to wish for the remarks of old experienced practitioners; in which light I may fairly be considered, having been much engaged in Midwifery for more than half a century. I think the Accoucheur attended his patient with an anxious desire to serve her well, and did every thing that he thought most prudent at the time. No one can act better than the best of his judgment dictates; and having acted conscientiously, I think he has no occasion to reflect on himself: every practitioner, however great may be his skill, will sometimes lose patients for want of better judgment; and he himself will think so when it is too late.The loss of this patient may be the cause of saving many lives; and I hope your Correspondent's mind will recover perfect ease. As to the case, I think if instead of twenty-five drops of laudanum he had given seven or eight grains of opium, the hemorrhage would have abated, and the os uteri have given way; the woman would not have been subject to faintings, nor required such excessive stimulants; and she would have been delivered many hours sooner. That the uterus was spasmodically affected, is proved by the grinding pains, sometimes termed spurious, at others colic : in those cases, the os uteri contracts instead of dilating; examination gives pain, and brings on hæmorrhage; and till this spasmodic state of the uterus is removed, (and noNo. 56 3 L thing but large doses of opium will effect the removal) true labour will be suspended: repeated small doses of opium will not have the same good effect as a large one. This medicine does not produce feverish heat, like wine or ardent spirits, yet it greatly exhilirates the patient; I have given it in doses from five to eight grains in more than a hundred cases, and once to ten grains, without any ill effect, but to very great advantage. A few years since I was called into consultation by an M. D. Accoucheur, who had been attending a lady three weeks, suffering under uterine hæmorrhage. On examination, I found the spongy part of the placenta presenting over the os uteri; the patient was between seven and eight months advanced in pregnancy, and speedy delivery became necessary. I advised five grains of crude opium to be given immediately, and to deliver by turning the child, an hour afterwards, when the uterus should be under the influence of the opium, and would not resist. At the appointed time I again attended, when the hæmorrhage had abated; and I then advised immediate delivery. Her medical friend was timid, and requested me to act; accordingly, I endeavoured to separate the placenta from the uterus, but found difficulty in doing it; I then passed my hand through the placenta, near the funis, up to the fundus uteri, took the feet, and delivered. The placenta was brought away soon afterwards, and the whole was accomplished without the loss of more blood than is usual in common labours. This lady was well enough to sit up the third day, and to nurse her child; she recovered rapidly. Perhaps your Correspondent would have been equally fortunate with myself under a similar treatment. In future, I advise him to consider himself as commander in chief, and not permit an exhausted patient to use improper exertion, or to suffer the company of visitors Another caution, still more important. Immediately after the placenta is removed, place a bandage round the body rather tightly. The use of this is to press on the large blood vessels, which have been long compressed by the impregnated uterus; this pressure being suddenly re moved by parturition, the abdominal muscles, long distended, do not recover their elasticity, the blood moves irregularly, and occasions fainting and sudden death. An immense number of women are lost for want of this caution, particularly those of relaxed habits, or who have had many children. From the above remarks you will see that I do not accord with your opinions on this case, and that a practitioner may safely steer between Scylla and Charybdis, but his oars must be opium and tea, instead of wine and spirits. Opium, in a sufficient dose, will always make the os uteri give way when affected by spasm; and if it is rigid from muscular vigonr, there will not be any hæmorrhage. Ipswich, May 10 1815. I am, &c. WILLIAM SPARK, M. D. Observations on the Difficulty of sometimes distinguishing between the Symptoms of Abscess of the Loins, and Hydrocephalus Internus; and between the former and certain Idiopathic Fevers of a Typhoid Type; with Cases. By a Staffordshire Practitioner. ( Communicated by Dr. Palmer.) THE connection subsisting between serous effusion în the ventricles of the brain and the congenital disease, called spina bifida, has frequently been remarked. My own experience and observation lead me to suspect, that affections of the encephalon and vertebral column are more frequently complicated, and mistaken for each other, than is, at present, commonly believed. Again, it is allowed by men, the soundness of whose opinions no one can dispute, that lumbar abscess is often, in its earlier stages, blended with a fever of the typhoid character; by which suppuration in the region of the loins is distinguished from purulent deposits seated in other parts of the body; as the |