Report on the progress of practical medicine, in the departments of midwifery and the diseases of women and children in the years 1845-6 / by Charles West.

Charles West

Date:: 1847

Credit: Report on the progress of practical medicine, in the departments of midwifery and the diseases of women and children in the years 1845-6 / by Charles West. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$it was thought prudent to discontinue their use. The child, however, then recovered without any further head symptoms. 3. DISEASES OF EARLY INFANCY. Asphyxia Neonatorum. M. Depaul* has written a very elaborate paper on the subject of artificial respiration, as a means of resuscitating still-born children. He instituted a series of experiments on the dead subject, with the view of determining the amount of danger of injuring the lungs by the in- sufflation of air. Hejatisfied himself that this danger is almost an imaginary one, since, even after the lungs were removed from the body, it required seve- ral most forcible insufflations, far stronger than would ever be made in the case of a still born child, to produce rupture of the pulmonary vesicles. On the other hand, he was struck with the great force needed thoroughly to in- flate the lungs, while their resiliency was sufficient to expel the greater part of the air. He found, moreover, in many cases where children had died suddenly after breathing for several hours or days, no other morbid appearance than an unexpanded condition of a large portion of the lungs. With reference to the mode of practising artificial respiration, he condemns the mere blowing into the mouth as inadequate, and recommends the use of a tracheal tube. He is of opinion that there is more danger of failing from imperfect insufflation, than of doing harm by its too forcible performance. It is of importance, likewise, that it should not be suspended on the first sign of breathing, but continued until the child cries loudiy, and respires well. Dr. Hotzf relates a case of the spontaneous fracture of the left parietal bone during a natural but tedious labour, in which the head was five hours in the pelvic cavity, although the pelvis was well formed. There were three fissures in the bone; one running into the sagittal suture, one to the anterior inferior angle, and the other to the middle of the anterior edge of the bone. The child was still-born ; much blood was effused under the scalp, but none into the skull. JMr. CloseJ quotes from a manuscript of Dr. W. Hunter’s, which he says was published fifteen years ago, an account of cephalcematoma, so complete as to leave nothing to be added to it. Dr. Hunter notices the deceptive sen- sation of the bone being perforated. He cautions, likewise, against the need- less cruelty of opening the tumour, which he says he leaves alone, and it disappears of itself. Trismus. Dr. Sims§ calls attention to the intense vascularity of the vessels of the spinal cord, and the effusion of blood around it, often met with in cases of trismus, and observed by him in the instance of which he has recorded the dissection. He endeavours to account for the spinal apoplexy, by assum- ing that the new-born child lying on its back, with a hard support beneath its yielding skull, the edge of the occipital bone is driven up under the parietal bones, and the cerebral circulation is thus interrupted. [It is scarcely neces- sary to remark, that any such mechanical theory of the disease is contradicted by the remarkable influence of climate in the production of the disease, and by such facts as its extreme frequency at one time in the Dublin Lying-in Hospital, and its almost complete disappearance after an efficient system of ventilation had been adopted.] Spina bifida. Dr. L. dc Thinnecour|| relates the history of the successful treatment of a case of this affection in a child aged two months, in which a tumour of the size of an infant’s head grew from the junction of the lumbar and sacral vertebrae. Instead of employing a common circular ligature, he used an instrument that acted on the principle of Dupuytren’s enterotome, then punctured the sac, and afterwards laid it open through its whole extent. Jn ten days the communication with the vertebral column was closed, and he * Journal de Chirurgle, May, June, 1045; and J. f. Kinderkr., Mar*. 1046. + Oesterr. Med. Jahrb., April, 1046. j Med. Times, Sept. 20, 1046. § American Journal of Med. Science, April, 1046. || J. f. Kinderkr., May, June, 1046.$