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
Catalogue details

Licence: Public Domain Mark

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.

    29/38 (page 27)
    t now removed the instrument, and placed a common circular ligature round die pedicle. The wound granulated and healed kindly, and at nine months old the child was perfectly well, and had had no return of the disease. The advantages of this mode of operating he conceives to be, that the membranes of the spinal cord are secured from the access of air after the puncture, that the two rods on each side of the spine form a substitute for the arches of the vertebrae, and favour the union of the serous surfaces, while they also help to diminish the space between the arches themselves. Dr. Beaunierf employed the common ligature in a child ten days old, with a spina bifida proceeding from the third cervical vertebra. Having tied it, he punctured it twice. Having tightened the ligature after the second puncture, the cyst began to become gangrenous, whereupon he cut it off. The wound healed, and four months afterwards the child was well. Dr. Williamson]; has described a very interesting case of imperforate anus, in which the rectum terminated in the urethra, the child, nevertheless, living for 8 months, and for 5 months of this time passing its faeces with moderate ase by the urethra. About that time, however, the child began to take other food besides the mother’s milk, its faeces became more solid, and escaped with .greater difficulty. Attacks of constipation of increasing severity now began to recur frequently, and in one of these the child died. The communication was found to exist at the membranous portion of the urethra, by means of a canal a quarter of an inch in diameter, and half an inch long, while the gut (terminated in a blind pouch. Dr. Williamson made an unsuccessful attempt 'during the life of the child to open the rectum, but was not allowed to repeat tit. He adds a caution against carrying the trocar too far backwards in ope- • rating in cases of this kind, since by so doing, the instrument may pass behind i: the rectum instead of puncturing it. Dr. Thore’s]; observations on peritonitis in new-born children contain much valuable information. The general characters of the disease appear to be the same as it presents in the foetus, and the same absence of puriform fluid in the abdominal cavity is noticed here. A dirty serous fluid, with fibrinous iflocculi floating in it, is often observed, and layers of pale membrane cover the intestines, and are especially abundant about the spleen and liver. In one third of the cases, 63 in number, pleurisy was found associated with the peritonitis, another point in which it resembles the disease as it occurs in the loetus. It appears, moreover, that this affection is most frequent during the first fortnight of existence, while after the first month it is very rare ; a cir- cumstance which suggests the doubt whether it does not, in some instances.) commence even before birth. In several cases, however, this certainly was not so, for M. Thore found that the season of the year had much to do with the pre- valence of the disease, and that it is most frequent during the spring and sum- mer season, partly, perhaps, owing to the wards of the hospital being then most crowded. He inclines also to the opinion that those conditions which favour puerperal fever likewise.increase the frequency of peritonitis in the infant; and he establishes, conclusively, the existence of a relation between infantile erysipelas and peritonitis, since 17 of 26 cases of erysipelas were combined with peritoneal inflammation, and a similar relation may be noticed between peritonitis and phlebitis of the umbilical vein. A sudden, tympanitic swelling of the abdomen is often the first symptom of the disease, and is soon associated with vomiting of a greenish mattei, which phenomenon, however, is seldom of long continuance. 1 he bowels aie generally constipated throughout, the respiration and pulse become aicc e- rate<l, the heat of the skin is increased, and the child evidently suffers pain in Aie abdomen. As the disease advances the countenance alters; the skin glows cold, and the pulse feeble, the child dying, in the great majority of cases, in J. f. Kindcrkr., July, 1B4G. Arch. G« n. tie M£d., Aug. and Sept., 1846. Med. Gazelle, May 1, 8, 1846.