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.

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    right angles to the first, at about an inch from each end, and the flaps carefully dis¬ sected back. An aneurismal needle, armed with a stout thread, made fast to the eye of a fine chain-saw, was now passed be¬ neath the clavicle, at about half an inch from its sternal end ; and the saw by this means introduced below the bone, which was then sawn through. Disarticulation of the acromial end was next effected, and a loop of string fastened to the bone, so as to raise it up while the remaining portion was separated from its attachments. No vessel of consequence was wounded, and no ligature was required. On examining the bone after removal, the disease was found to be caries, which had extensively affected the under surface. It was also found that the whole of the diseased por¬ tion had been taken away. About half an inch of the sternal end was left attach¬ ed to the sternum. No pain was felt dur¬ ing the operation, chloroform having been administered with perfect success. The lips of the wound were brought together with sutures and straps of plaster, over which lint, dipped in cold water, and a bandage, were applied. The arm was also properly secured to the side. The patient rapidly recovered, and left the in¬ firmary in a month. On the 15th March, she was in a condition to go through her household duties, and felt her arm becom¬ ing every day stronger. There was no sinking of the shoulder, and, except when closely examined, no appearance of dis¬ figurement. [This is at least the third case in which nearly the entire clavicle has been remov¬ ed. Previous to this the inner and outer thirds of the bone had been removed; the former by Mr Davies, in a case related by Sir A. Cooper, in which the bone had be¬ come gradually displaced backwards, so as to interfere with the oesophagus; the lat¬ ter by Velpeau, for necrosis. A case is re¬ lated by S. Cooper, in which Dr Mott of New York removed nearly all the clavicle, on account of a large osteo-sarcoma, a small part only at the acromial end having been left; and Mr Syme has related a case (Pa¬ thology and Practice of Surgery), in which he removed a similar extent of the bone on account of a tumour, involving the greater part of its length, the acromial end of the bone, to the extent of an inch, being purposely left with the view of caus¬ ing less injury to the connections of the shoulder. Mr Syme remarks—“ The only part of the operation in the slightest de¬ gree difficult or embarrassing, was in se¬ parating the large articular surface of the bone from its connections, where the vi¬ cinity of the pleura and venous trimk ren¬ dered extreme caution requisite.” In Mr Potter’s case no ligature was required. In Mr Syme’s three small ves¬ sels were tied. In Dr Mott’s forty liga¬ tures were applied, and the external and internal jugular veins were tied and divided. All the patients did well.] 343.—Paralysis of the Bladder cured hy Galvanism.—An Interesting case of this kind recently occurred in the practice of M. Monod, surgeon to the Maison de Sante. A -woman, fifty-seven years of age, labouring under an incurable disease, endeavoured to commit suicide by means of charcoal fumes. She was relieved in time, but an obstinate paralysis of the bladder remained. M. Monod suggested a trial of galvanism to the neck and fun¬ dus of the bladder. On the first applica- cation the patient was enabled to make water without assistance, and her re¬ covery was rapid.—Med. Times, July 14, 1849. III.—MIDWIFERY, AND DISEASES PECULIAR TO WOMEN. 344.—Case of Twins of Extraordinary Size. By Dr Bertolet, of Oley, Penn¬ sylvania.—“ Early on the morning of the 15th of April 1848,1 was requested to meet Dr Thompson in consultation, at five o’clock, in the following case :— “ Mrs A. H., in her sixth labour, was seized -with regular pains at ten o’clock on the previous morning, and at two o’clock, after having been in labour four hours, was delivered of a fine vigorous female child. The vertex presented to the left acetabulum, and the infant, after it was born, weighed nine and a-half pounds. The labour pains then ceased for a time. but soon recurred with increased violence. Upon examination, the right hand of an¬ other child was discovered high up in the vagina; this was returned within the uterus, after which the vertex presented very nicely in the second position at the posterior strait. We now had hopes that all further assistance would be unneces¬ sary; but after waiting for a considerable time, the head still continued in exactly the same situation. There had been a constant flow of blood from the time the first child was born, and the patient’s strength was becoming exhausted. I suc¬ ceeded in applying the long forceps after