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tion of parts, adhesive matter, instead of mucus, might have been poured forth, and thus, by adhesion, as pregnancy advanced, the orifice have become entirely obliterated ?”
For the probability of such a state of things having existed in this case, he relies upon the facts of it, as already detailed : and in support of the possibility of such an adhesion's taking place, he quotes first: a case by Dr. A. S. Thomson, of a woman aged 65—who died of dry gangrene-in whom the uterus was found containing 8 quarts of dark brown fluidits mucous membrane healthy—and the os uteri interiorly “as completely obliterated as if it had never existed”—and internally, or upon its vaginal face, but “faintly marked.” Secondly, a case, in which a woman died in labour, from rupture of the cervix uteri, there being no trace of a normal os uteri, save something like a dimple at its ordinary site. Thirdly, a case by professor Hamilton of Edinburgh, of a healthy young woman, who had menstruated regularly up to the time of her first pregnancy–who went to the full termhad severe labour pains, which were ineffectual from an adhesion of the vagina to the extent of an inch, about two inches from its external orifice, which was opened by an incision, when shortly after the labour terminated favourably.
We have thus given all of the important facts connected with this most interesting case.
7.–On Incision in cases of Occlusion and Rigidity of the
Uterus. By Samuel Ashwell, M. D.
The object of this paper of Dr. Ashwell's is to show
“1st. That incision is the safest remedy, where the os is in a state of firm and complete closure; or, in other words, where the uterus, so far as its lower orifice is concerned, is imperforate: and
2dly. That in examples of such extreme rigidity of the os, where, after hours of strong uterine effort, the power of dilatation is entirely absent, whether such rigidity arise from disease in the structural organization of the part, or has resulted from previous laceration and ulceration, incision is the best and safest treatment; far preferable to protracted and powerful dilatation of the os by the finger; or, on the principle of non-interference, to leaving the case to the natural efforts.”
Complete closure of the os-uteri may result from adhesive inflammation, in cases where the aperture is unusually small, and as a consequence of “morbid deposit about the os and cervix, produced either by chronic inflammation or occurring as the result of former laceration or ulceration."
The only condition with which occlusion may be confounded, is obliquity of the uterus; particularly ante-version, in which the os is thrown far upwards and backwards; towards or at the promontory of the sacrum. In regard to the practicability and mode of distinguishing occlusion from obliquity, the Doctor observes
" There can be but little difficulty in the diagnosis of instances of complete and firm closure of the os. turient effort is really established, the lower portion of the uterus, in the form of a tense and large globular mass, is generally forced down very low, sometimes so far, as nearly to reach the external entrance of the vagina. Thus a fingerat all practised in these inquiries-must detect an aperture, if there be one; and, if not, the spot where the os uteri, at the time of conception, had been.
A repetition of uterine action will afford abundant opportunities for careful re-examination; so that no apology for indiscreet and dangerous delay can exist. If, too, a spot shall be discovered-more depressed, and of different structure to the surrounding parts, indicating the site of the os uteri at the time of impregnation, it is impossible then to doubt about tne nature of the case; and the only question remaining to be determined, is the precise method of relief."
When upon the subject of treatment, and after urging in strong terms, the impropriety in these cases of occlusion of venesection, and permitting the labor to be protracted to a great length of time, in hopes of discovering an os uteri, or that nature will remedy the evil, the Doctor says: “there are two methods of remedying the closure of this important orifice:
1. By such an amount of pressure by the finger, female catheter, sound or bougie, as shall puncture or open the occlusion: and
2. By incision made by a bistoury or knife.”
The first named method may be employed when the occlusion is slight, and depending upon a thin membrane stretched across the os. But the author differs from some writers upon the subject, in thinking that incision is preferable, when this membrane has become completely organized, firm and unyielding. And he also recommends incision when the occlusion is dependent upon adhesion or morbid deposit. He assigns two reasons for this preference. First, that if the finger or bougie, &c., be employed, contusion of the part will necessarily follow, and thus render the patient liable to local or general uterine inflammation. Secondly, he thinks that there is less liability to extensive laceration where a free incision is made, than where a small puncture is made by any of the above mentioned methods. In support of this last position, he cites some cases in which incision was employed, with the effect first named.
Rigidity, which is treated of in the second division of his subject, and which is of much more frequent occurrence than occlusion, may (in that form of it which requires incision) result from a contracted orifice being surrounded by a "structure almost entirely undilatable,” or from the cicatrization of abscesses, ulcerations, &c., or from a hard tumor or malignant deposit, which alters the structure of the part.
If the nature of the case be made out in the early stage of labor, it is considered not only prudent but highly important to resort to bloodletting, antimony, opium, &c., with the hope of producing relaxation. But when these means have been resorted to and a sufficient time has been allowed to give nature, with these adjuvants, an opportunity of overcoming the rigidity, and without success, the author says: “ The case may then be treated by artificial dilatation or by incision, or it may
be left to nature. To adopt the last course, he considers, would be to consign the woman to unlimited laceration or death by inflammation from protracted uterine contraction. To artificial dilatation he is decidedly opposed, for the same reasons which have been assigned against its employment in occlusion. In regard to incision he thinks it should be at once resorted to, wnen it is perceived that nature is unequal to the task. “ If there be distressing and constant pain about the neck or body of the uterus, or in any other part; if the countenance becomes turgid and dark; if perspiration issues at every pore, and the pulse is full, strong, quick and incompressible; and if these symptoms continue, although perhaps somewhat lessened by bleeding and antimony; there can be no doubt that recourse snould be had to the incision."
We should not wait until the woman is worn out by fruitless contractions, and is already in it state of collapse, when the operation would of course be unavailing towards saving the life of the patient.
After describing the manner of performing the operation, (which is so simple, and will suggest itself so readily, as to render a description of it unnecessary here) Dr. Ashwell devotes the balance of his paper to detailing some cases in which incision had been employed, in which no unpleasant consequences grew out of its use, and success attended it when carly enough resorted to.
Selections from American and Foreign Journals.
A new article of the materia medica, the Monesia, of South American growth, having attracted no inconsiderable share of attention in the French metropolis, has been recently introduced to the profession in this country by Joseph G. Nancrede, M.D., whose opinion of the eclat which it is destined to win, may be inferred from his eagerness to be the first to extend a welcoming hand to the new comer. We introduce the stranger to our readers, by presenting Dr. Nancrede's letter. To the Editors of the Medical Examiner:
GENTLEMEN:~With the intention of extending a knowledge of the properties of monesia, and of thus rendering practically useful, to our community, the very interesting paper of Dr. Martin Saint Ange, a translation of which appeared in the last number of your journal, I beg leave, through the medium of its pages, to acquaint the medical profession, that a portion of monesia, recently received from Paris, has been placed in the hands of Mr. F. Brown, corner of Fifth and Chesnut streets, where it can be obtained by those who may wish to prescribe it.
The preparations which have reached me, and which are to be obtained here, are, 1, the aqueous extract; 2, a syrup containing about six grains of the extract to the ounce; 3, a hydro-alcoholic tincture, containing about thirty-two grains to the ounce; 4, an ointment, containing one-eighth of its weight of extract.
While on this subject, I may be permitted to state, that having had in my possession for about a week, this new substance accompanied by the Gazette Medicale de Paris, of 19th