cellular tissue. Immediately under the sac, and blended with it, was the anterior crural nerve, much larger than natural in appearance, from thickening, probably, of its cellular neurilemma. The vein along side was healthy, but thickened, and the cellular tissue at this point, infiltrated and indurated. Just here existed a communication between the vein and artery. A little cyst of bony shell was attached to the surface of the vein, just where the saphena dips into it. The case Dr. V. B. believed to be unique; an aneurismal varix, and a true aneurism of the femoral artery. The large quantity of indurated cellular tissue above the disease, and the exaggerated thrill gave the idea of a much larger aneurism than really existed. The injury done to the artery had caused disease of its coats and aneurism. There was also decided hypertrophy of the heart, with induration of its tissue; no ossific deposits. Each cavity contained a polypus, quite white and apparently formed before death. Dr. V. B. said that a patient operated on by Mr. Ramsden, with subclavian aneurism, went on well for some days, with slight oppression of the heart, and died suddenly. A polypus existed in the descending vena cava, depending into the right auricle, which acted as a valve and caused death. Hence, he inferred, that there might be something in the ligating of large arteries, which led to this condition. The heart, in Dr. M.'s patient, beat very irregularly after the operation and intermitted.-N. Y. Annalist. A Notice of the Grayson Springs. By LUNSFORD P. YANDELL, M. D. The present proprietor of the Grayson Springs, in the summer of 1833, learning that quite a number of infirm people had gone to them in the woods, and were encamped about them in tents, was induced to purchase and improve them. It seems that, many years ago, they acquired, by some accident, a reputation for curative virtues, and this they have continued to enjoy. On a visit to the springs last summer, I met with a large company of invalids, and learned from many of them that they had not been disappointed in their hopes of renovated health from the use of the waters. I saw some lodged in hired cottages, near the springs, who were not able to pay for board at a tavern, and had brought with them their beds, provisions, and cooking utensils-a fact which testifies to the strong popular faith in the efficacy of these springs. The springs, issuing within an acre of ground, are five in number, and, although differing in temperature, and slightly in taste, contain essentially the same ingredients. The Rock spring is the coldest; the Stump spring is so warm as to be unpalatable, and its water is chiefly used to supply the bath-house. The water of the Centre, Moreman, and McAtee springs has a pleasant temperature. Of these the latter is perhaps the favorite fountain. It takes its name from an early visiter, a lady, whose health is said to have been restored by the use of its waters. The following are the ingredients found in these springs: Sulphuretted hydrogen, Carbonic acid, Carbonate of magnesia, Carbonate of lime, Carbonate of iron, Sulphate of magnesia, Sulphuretted hydrogen is the most characteristic constituent of the waters, and, with the carbonic acid, renders them light. The first effect of drinking them is an increase of perspiration; the bowels are generally gently moved, and the appetite and powers of digestion improved. To generalize, the action of the Grayson springs may be said to be gently tonic, laxative, and alterative. These springs occur in a different formation from the other noted mineral springs of Kentucky; as they also differ materially from most of them in their constitution. Sulphate of magnesia is the most prominent ingredient in the Harrodsburg springs, which is recognised by its bitter taste; and although the same article is found in the Grayson springs it is in too minute a quantity to affect the taste of the water, which is sweetish. The Blue, Bigbone, and Drennon's Licks, the Olympian and Paroquet springs, all abound in common salt, which is absent from the waters of Grayson. They all, except the Olympian, occur in the Blue Limestone, the oldest of our fossiliferous rocks; the Grayson springs are found in the Carboniferous limestone, immediately below the coal series. The stratum from which they issue is the same in which the Mammoth Cave occurs, the Pentremital or uppermost layer of the most recent of our limestone rocks. In this rock, in the immediate vicinity of the springs, Pentremites, Archimides, and many new and most beautiful species of Encrinites, are found. The locality is one of exceeding interest to the geologist. Louisville, Jan. 26th, 1847. Western Journal. Western Schools.-From the numerous medical schools in the Valley of the Lakes and Mississippi, we have received the official reports of only two. The Medical Department of the Western Reserve College, established three or four years ago at Cleveland, Ohio, gives in its catalogue two hundred and sixteen names; which is a remarkable growth. The Medical College, of Ohio, at Cincinnati, has reported to the Legislature one hundred and seventy, as its number. The other Ohio school, Willoughby University, which for ten or twelve years has been established at a village near Cleveland, is, as we perceive, by an act of the Legislature, to be transferred to Columbus, the seat of government of that State. Its Faculty will, as one of the Professors lately informed us, be there re-organised, when we shall give the names of its professors. We do not know the number of its present class.--Ibid. THE MEDICAL EXAMINER AND RECORD OF MEDICAL SCIENCE. NEW SERIES.-No. XXVIII.-APRIL, 1847. ORIGINAL COMMUNICATIONS. Artificially Shortened Funis-with Rupture before Delivery. Read before the Northern Medical Association of Philadelphia, January 21st, 1847. BY WILSON JEWELL, M. D. Numerous causes have been assigned by obstetricians for protracted and difficult labour. Among others will be found, "a short funis," and "one or more coils of the cord around the neck of the child." The first of these may be viewed as a natural or an absolute, the latter, as an accidental or relative cause for delay in the birth. A cord short enough to retard delivery, could in no instance be coiled around the neck of the child, and a cord of a length sufficient to enable the child to pass through a loop once or oftener, could be no hindrance to the free exit of the foetus without this occurrence, hence, these may be considered and treated of, as separate and distinct causes for tedious labour. A shortened funis, either natural or accidental is so seldom the cause of tedious labour, or so rarely demands artificial aid in the progress of delivery, that some authors have not classed it among the causes for complicated labour, while others lay but slight stress upon it, deeming it of too little importance to require a special section for its consideration. Yet it does occur, though but rarely, and according to Moreau is one of the causes in the fœtus for rendering natural labour artificial-is an obstacle to parturition, exposing the mother to accidents, and endangering the life of the child. Collins, in his practical treatise on midwifery, makes no allusion whatever to a naturally shortened funis, as though it never occurred, and has only a bare reference to an artificial shortening of the cord, under the head of natural labours, where he directs that the cord when around the neck should be brought over the head or passed back over the shoulders-for fear that the cord might act as a ligature, pressing on the neck of the child and checking the circulation—or injure the mother by dragging away the placenta, causing hemorrhage, or by inverting the uterus; but he gives no certain directions how to proceed in the event of not being able to remove the cord, either by passing it over the head or back over the shoulders. Nor can I find, that in the 16,654 births of which he gives the result, there is one instance recorded of shortened funis. Baudelocque, of whom our American Baudelocque, the lamented Dewees, said he held himself indebted for nearly all he knew on midwifery-Baudelocque, whose genius and well tried experience none will doubt,-holds the following sentiment on this point of practice, which he places under the head of causes of preternatural labour. "It is generally supposed that the cord by its shortness, or frequent windings on the child, opposes obstacles to delivering; such as keeping the head back, or if it allows it to advance during pain, it makes it recede immediately after; thus mistaking the reaction of the perineum and bones of the cranium, for the action of the cord. This will point out the futility of the advice of some authors who recommend the cutting of the cord, &c." Dewees follows in this instance, very closely his master Baudelocque, but goes a little further. In his section on "Too short a cord," he says, "I shall not positively deny, that too short a cord, either artificial or natural will interrupt a natural labour, but I must say, I have never seen an instance; and also that I entertain strong doubts of its possibility." Rigby, in his valuable work on obstetrics, gives practical directions in case of an accidental short cord, and its acting as a ligature on the neck of the child, and where it cannot be removed, to divide it—but adds, "we believe that this is rarely if ever necessary; for in proportion as the child advances, so does the fundus descend, and thus relieves, in some measure, the tension to which the cord is exposed." Under the head of difficult labours from faulty condition of the parts which belong to the child, he admits that "the umbilical cord may obstruct labour, by either being too short, or rendered so from being twisted round some part of the child," but on the very next page, as though he had forgotten his admission which I have just quoted, he says, "we quite agree with Professor Naegle, that unusual shortness of the cord can rarely if ever retards labour," and then again on the following page he adverts to the twisting of the cord around the neck, and adds, that it may not only retard labour, but destroy the child, by preventing the free return of blood from the head, either before the birth, or during the actual process of labour. He also cites La Motte's and Burton's cases, where it became necessary in one case to cut the cord, which was done before the head was expelled from the os externum, in order to relieve the mother from danger and save the life of the child. The cautious Blundell, who is certainly a very discriminating and safe practitioner, treats this whole subject very loosely. On page 111, he makes mention of the cord being coiled round the neck six or seven times, and gives directions about removing it, but closes his remarks by saying, "a better method is to leave the cord around the neck, until the body be born, when it may be disentangled with facility." Under the variety of laborious labour, page 312, the same author doubts whether brevity of the cord gives rise to laborious labours, and thinks the shortness of the cord never makes itself felt, until after the head has escaped the vagina. Ramsbotham in his practical work on midwifery, does not cite a case, in all his experience, of a short funis either natural or artificial, becoming the cause of protracted or dangerous labour involving either mother or child. Lee, on the other hand, p. 240,* says that a short cord is the cause of delay, and cites Smellie's case, where the funis was three times around the neck, and where labour was protracted several days. He also says, unequivocally that from shortness of the umbilical cord without surrounding the neck of the child, it has been torn during the expulsion of the trunk and lower extremities. When the cord is around the neck of the child, he says the labour is sometimes protracted, and the head of the child retracted or drawn up after every pain, and that the cord has to be tied and divided before the child's body can be born. Burns says, the cord may be on the stretch, but it never happens that it is torn, p. 79. vol. 2. When the head is born with the cord around the neck he says, that some advise the cord to be cut, but his opinion is, that such a course " is rarely necessary, for the child may be born, though the cord remain about the neck." The late Dr. James of this city, was of opinion, that retraction of the head was rarely caused by shortening of the cord or its being coiled around the neck-but was occasioned by rigidity of reaction of the external parts of the mother. *Edition Select Medical Library. |