low of my hand, I raised the whole head up out of the pelvis, and as it became disengaged, by a very little traction with the points of my fingers, the chin fell back towards the sternum, and fortunately at that instant the uterus began to contract with great force. The head being now in the first position I withdrew my hand as it advanced, and the whole cranium was born with the same pain, and the body with the next. The placenta was thrown off in about fifteen or twenty minutes. The mother and child both did well. April 13th, 1842. Mrs. Beckley, residing in Mifflinburg, sent for me in the evening. On examination I found the face coming down with the chin in the hollow of the sacrum, the os uteri but partially dilated. Encouraged by my success in the treatment of the former case, I now awaited the dilating process very attentively for about two hours, when it became sufficiently great to operate. I then had my patient placed on her back near the bed stock, and directing an assistant to support the left knee, while I supported the right myself, I introduced my hand into the vagina, placing two fingers on each side of the nose, having the forehead in the hollow of my hand, I disengaged the head from the pelvis by raising it up, at the same time directing the chin towards the sternum. The head being now in the first position, I withdrew my hand as it advanced. The labour progressed speedily and safely. The mother and child both did well. April 21st, 1842. Mrs. Kleckner, about to be confined the eighth or ninth time, sent for me in the afternoon. On making an examination, "per vaginam," I found this also to be a face presentation, and in every respect similar to that of Mrs. Beckley, which occurred but eight days before. It is sufficient to say that I treated this case precisely as I did Mrs. Beckley. Mother and child are both living and well at this time. Case of Retention of Fatal Bones in the Uterus during four years. Communicated in a letter to the Editor, by JAMES B. ELLIS, M.D., of Ripley, Miss. On the 29th of January, 1846, I was called by Dr. James Thompson, to see Mrs. Mary Ann Fields, about 25 miles distant from this place, aged 27 years, who gave me the following account of her case: In Cass county, Georgia, early in April, 1842, she was confined at full time in her first pregnancy; her labour was very lingering, and the physician she sent for advised her to trust to the powers of nature, and left her. Her pains soon after ceased. At the time, she One was unable to rise from her bed, and she therefore sent for two other medical gentlemen, and requested them to assist her. They told her that her pains would very probably return again, and all would terminate well. Her pains, however, did not return, and in about four months after, the decomposed flesh of the child commenced passing off rapidly, per vaginam; she said the fetor was insupportable to her friends, so much so that visiters could scarcely come into her room. In about six months from her confinement to bed, the discharges ceased, and her health began to improve rapidly. From this time her menstrual discharges returned, and continued regular in time, quantity and consistence, for more than three years. During this period there was a tumour in the epigastrium, that always gave a dull pain on pressure. Her disposition was cheerful, and continued as good as usual during this time. She consulted every medical gentleman that she could conveniently, but none agreed with her that the bones of the foetus remained in the uterus. expressed it as his opinion that the case was one of extra uterine conception. This, however, could hardly have been so, for she says the putrid flesh passed away rapidly per vaginam. About the middle of the summer of 1845 she was taken with typhoid fever, a disease that prevailed very generally in this section of country at that time. During the existence of her illness, there was considerable pain developed in the tumour spoken of, and she expressed to her attending physician her confident belief that the bones of her child were still in the uterus, and requested him to endeavour to extract them, but she said he only laughed at her and told her such a thing was impossible. After the abatement of her fever, her physician discontinued his visits, but she was still unable to walk from the violence of the pains in the uterus. During the succeeding winter, my friend Dr. James Thompson was called to see her. He found the tumour very large and painful, and the os uteri hard, and apparently sealed, and her general health very bad. He commenced treating her case on general principles, giving her tonics, alterants, anodynes, hip baths, etc. During the time I was occasionally consulted by him with reference to her case. A few days before I was first called to see her, she passed several very hard rough substances per rectum, which on examination were found to be bones. In a day or two she passed 25 or 30 bones, mostly small. At my request, Dr. Black accompanied me to see her, and on examination per rectum, I could distinctly feel a large fistulous opening from the rectum to the uterus, and could tell from her discharges that ulceration was going on rapidly. The ends of some of the long bones passed into the rectum and prevented a free discharge from her bowels, and at every attempt at defecation the bones were borne down against the raw edge of the fistula, which gave her excruciating pain. We had no instruments with us at the time for extracting the bones, having gone as much for curiosity as any prospect of doing her any good. We mustered up such rude instruments however as we could command on the spot, and requested Dr. Laird to assist us. With these we dilated the rectum, and with a pair of long curved forceps extracted the projecting bones. The operation was so very painful, the whole mucous membrane of the rectum being ulcerated, that she utterly refused to suffer any attempts at further efforts. She said she knew she would die, and would not suffer any pain that she could avoid. We recommended Dr. Thompson to use anodyne mucilaginous enemas, pulv. charcoal, as a laxative, warm astringent hip baths, and such tonics as she could bear. This treatment she submitted to, although sometimes reluctantly. She continued to pass off bones more or less every day, and sometimes entertained hopes of recovery. At her death, (about the 20th of March, 1846,) Dr. Thompson thought she had discharged nearly all the bones, only a few of the cranium remaining. The fistulous opening was very large at the time of her death. A post mortem examination, I regret to state, could not be obtained. The statements made by Mrs. Fields, of her symptoms and sufferings, are all confirmed by her husband, and I have no doubt of their correctness. Some of the bones are in my possession now, which I will exhibit to you next winter, when I hope to have the pleasure of listening to your lectures again. I have the honor to be, very respectfully, On the Inhalation of Sulphuric Ether. By J. B. FLAGG, M. D. of Philadelphia, Surgeon Dentist. The medical world is pretty fully advised as to the narcotic influence of this drug, when its vapour is inhaled into the lungs under peculiar circumstances. Desirous of promoting the cause of science, and curious to test its efficacy when applied to painful operations, I have been engaged for several weeks past in experimenting with it, both in its pure washed state, and compounded to a very limited extent with oil of wine; first upon myself, and then upon many friends. I will proceed to give a few remarks as to its legitimate use, and its recent illegitimate introduction to the profession of surgery. The effects of sulphuric ether, when inhaled, have long been known to be similar to those of nitrous oxide; varying, according to idiosyncrasy and to the object in view. If inhaled with a certain degree of doubt as to its capacity to effect, it is most sure to produce a melancholy train of thought for the time being, accompanied with weeping or other symptoms of distress. If taken with a view to produce merriment, its tendency, in a large proportion of cases, is to induce pleasurable sensations, as evinced by laughter, dancing, grotesque gestures, &c. When taken for the purpose of submitting to an operation, the mind of the patient, having dwelt much upon the ultimate object to be attained, is calmed and trained to that perfect state of inactivity, which allows the operation to proceed with but slight, if any, disposition to resist, on the part of the patient. The cerebrum, while under its influence, acts from exciting causes, similar to those which occur frequently during natural sleep; that is, external circumstances will suggest the idea. Two cases will serve to illustrate: Miss F., a young lady about 18 years of age, of nervous temperament, had two teeth removed after two minutes inhaling the vapour; she was at first perfectly quiet, opened the mouth at my request, and allowed the instrument (forceps) to be placed upon the tooth; but as it was necessary to force them well under the alveoli, she made considerable resistance, and appeared to suffer much; she screamed loudly, saying, "stop pulling." In less than two minutes after the teeth were removed, and when the effect had entirely passed off, she assured her mother that she had not been in the least hurt. Upon being questioned as to why she manifested so much distress, she replied that her dreain was an unpleasant one; that she thought she was on board a vessel, and perceiving that they were going upon the rocks, she called to the man at the helm to "stop pulling" supposing that the vessel was propelled by this means. Now as the words made use of were a natural outcry, I prefer to attribute to them the suggestion of the dream, than to marvel at the coincidence. A young man, æt. 20, was desirous of having a painful molar of the lower jaw extracted; his doubts were very great as to the possibility of destroying sensation; but still desired the experiment. For this operation I used the German Key; he manifested considerable pain; carried his hand to the mouth; swayed the body forward and back, as in much agony. I asked if it hurt him much; he said, "indeed it did." I then requested him to tell me if the tooth was out; he said, "no." Here I made the remark that it was a humbug; he immediately replied that "it was a humbug”— that he did not believe it could be done"-" expected to be imposed upon when he came." At this point he recovered consciousness; smiled when I showed him his tooth; assured me that he suffered no pain whatever. Upon my asking him why he called it a humbug, he denied having said so; clearly illustrating that his ideas. for the moment were dictated by my method of treating the matter. From various experiments, I am satisfied that it is by no means necessary to produce entire unconsciousness, in order to act suf ficiently upon the sensorium to allow of any operation being performed, of not more than two or three minutes duration. Several recent cases have been so treated by me that my patients were perfectly aware of their position; having a full knowledge of every process in the operation; and expressing themselves, invariably, as much delighted with the result; one stating that "it felt like extracting the tooth from a block of wood." The medical properties and uses of sulphuric ether are well described in Wood and Bache's Dispensatory, page 810: "A powerful diffusible stimulant, though transient in its operation" "It is also esteemed anti-spasmodic and narcotic." "Its vapour, when breathed, produces a transient intoxication, resembling that caused by respiring nitrous oxide, but dangerous if carried too far " "It is beneficial in some stages of low fevers; likewise good in nervous headache, unattended with vascular fulness-some stages of hysteria; and generally in nervous and painful diseases, which are uraccompanied by inflammation." "In catarrhal dyspnoea and spasmodic asthma, its vapour may be inhaled with advantage. In nausea it is given as a cordial; likewise in cramp in the stomach, &c. From this abbreviated quotation from the above-mentioned work, it will be seen that the medicinal virtues of the article under consideration, have been well understood by the profession for a long time; and that it is esteemed an agent of so much potency, as to be used with much caution, even by the faculty; hence I am at a loss to comprehend the validity of a certificate, emanating from the hands of one quack authorising another of similar pretensions to administer it under any circumstances whatever. And should any accident occur in this view of the case, I trust that the medical and legal world will know how to discriminate. I would not be understood as speaking lightly of all those gentlemen engaged in the dental art, who may not be provided with medical diplomas. There are many such, whose work show them to be highly deserving of public confidence; and it is my belief that all who may be desirous of employing this agent, will be so led in their studies, physiological and pathological, that they will sooner or later demand and receive such testimonials as must serve to elevate our much abused and down-trodden profession. It is much to be hoped that some attention may be bestowed upon this subject by our medical colleges: suffering humanity demands that the whole question be properly investigated and put upon such a footing as will secure to the community what Dr. Bigelow, in his article of the 18th Nov., Boston Med. and Surg. Journal, seems so desirous of accomplishing-A SUITABLE GUARANTEE AGAINST ITS ABUSE. |