Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner.

Date:
MDCCCXLIX [1849]
Catalogue details

Licence: Public Domain Mark

Credit: Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner. Source: Wellcome Collection.

    17/262 (page 15)
    Months of Pregnancy in Cases of Placenta Prcevia. By Dr Scanzoni.—Ever since the time of Levret the occurrence of un¬ avoidable hemorrhage during the three last months of pregnancy has been as¬ cribed to the development and disap¬ pearance of the cervix uteri from above downwards—in other words, to the dila¬ tation of the internal orifice of the neck of the womb. This theory Dr Scanzoni considers far from being proved. He believes that in advanced pregnancy the external, and not the internal, orifice of the neck of the womb becomes dilated and expanded over the lower surface, as it were, of the womb itself, and that the internal orifice, composed of contractile tissue, remains undeveloped, and forming the single opening into the cavity of the organ. These remarks may be easily verified in the case of a primipai’a, or where the nabothian follicles are well developed. In such cases the lips of the lower orifice of the cervi.x uteri may be seen or felt at some distance from the os, and expanded around it in the form of a circle. Further, Dr Scanzoni remarks that, during the first six months of utero-ges- tation, it is the upper half of the womb which is chiefly or almost exclusively de¬ veloped, in order to enclose the enlarging ovum ; that it is during these same six mouths that the mass of the placenta be¬ comes most rapidly increased in size, and consequently that when inserted, as is usually the case, upon the lateral walls of the uterine cavity, it grows consentane¬ ously with these walls. But, on the other hand, during the three last months of pregnancy, the lower half of the uterus expands very rapidly. The uterus, which up till the sixth month was pyriform in shape, now becomes ovoid. And if the placenta, having attained nearly its full development during the first six months, finds itself implanted over or near the cervix, which is developed during the last three mouths, then its vessels are liable to be put on the stretch and rup¬ tured, by the disproportionate growth of that part of the uterus on which it is in¬ serted, and hence the hemorrhagy.— L'Union Medicate, Nov. 21, 1848. 22.—Case of Early Pregnancy. By Mr John Smith of Coventry.—Julia Amelia Sprayson, twelve years and a half old, was delivered on the 16th September of a living healthy child. She made a good re¬ covery, and had a copious flow of milk. She menstruated for the first time when she was in her eleventh year, and a few months afterwards was seduced. Several examples are on record where pregnancy has occurred in very early life ; but our author is not aware of any well-accredited case, in this country, of a child at twelve and a half years of age giving birth to a living healthy infant.—Medical Gazette, Nov. 3, 1848. 23.—Puerperal Insanity. By Dr Web¬ ster.—In a valuable communication to the Westminster Medical Society, on the subject of puerperal insanity. Dr Webster entered at considerable length into the statistics of the disease. To illustrate its frequency as compared with that of other forms of mental derangement, he stated, that in 1091 curable female patients re¬ cently attacked by insanity, and admitted into Bethlem Hospital, during the last six years, 131, or one eighth of the whole, were puerperal cases; thus showing that the malady is not so unfrequent as many may perhaps believe. Again, as to the curability of this form of mania, more recoveries were reported than in the other varieties of lunacy; 81 puerperal patients having been cured, or at the rate of 6 ] '83 per cent.; whereas the average recoveries during the last twenty years, in all cases of insane females treated at this institution, was 53‘67 per hundred. Hence, three in every five cases of puerperal insanity may be confidently expected to get well within a year. In regard to hereditary tendency to mental disease, 51 of the 131 patients were so predisposed, or 39 per cent, ; whilst 41 were suicidal, being at the rate of 31 in every 100. Both these peculiar¬ ities are of much importance in this malady, and materially influence the dis¬ ease, its progress, and result. The total deaths in the 131 puerperal patients amounted to six, or four and a half per cent., thus making the average rate of mortality nearly the same as in the other species of insanity, taken collectively. The parti¬ culars of the fatal cases, and pathology, next occupied attention, and Dr Webster stated, that three of the six patients who died were suicidal and hereditary; one was only hereditarily predisposed to insanity, but not suicidal ; whilst two, it was report¬ ed, had neither of these peculiarities ; and none ever w'ere insane previously. In addition to these facts. Dr Webster also mentioned, that half the deaths occurred in patients who were not affected longer than fifteen days, the shortest period being eleven days, and all were attacked by insanity within seventeen days after their confinement. In none of the dissect- tions were any morbid appearances oh-