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

  • Charles West
Date:
1847
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Licence: Public Domain Mark

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

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    inverted uterus by ligature. The inversion had existed since the patient’s delivery two years before, and for the last 18 months she had suffered from constant and profuse hemorrhage. The ligature, which included the whole body and cervix of the uterus, came away on the .9th day, and 3 months after the operation, the patient continued perfectly well. Inflammation and ulceration of the os and cervix uteri. Dr. H. Bennett* has published a series of cases, some of them of considerable interest, illus¬ trative of the views on ulceration of the cervix uteri contained in his recent work on that subject; and some papers on similar topics have been published by MM. Boys de Loury and Costilhesf. M. Pichardf attacks what he re¬ gards as the too general employment of local cauterization for the cure of various diseases of the os and cervix uteri. The train of argument which he pursues, is to the effect that the cervix uteri being composed of various dis¬ similar tissues, while the effect of caustics is not confined to the one supposed to be diseased, but extends to all, changes in all result, and any tendency that may exist to cancerous degeneration is thus called into activity. [It cannot be denied that cauterization of the os uteri is sometimes improperly resorted to, and that in other cases a milder treatment would have sufficed for the cure of the patients’ ailment. M. Pichard, however, though he speaks of a “host of observations,” does not adduce them in confirmation of his statements that cancerous degeneration is often induced by this treatment. In the only case which he relates, where the death of the patient succeeded to cauterization of the cervix, he did not see the patient during the last month of her life, no examination of the body was made after death, and she is asserted to have died of carcinoma, only on the evidence of her daughter as reported to M. Pichard by a third party. Hence, although treating of a subject that well deserves careful investigation, the book is in the highest degree unsatisfactory. The remarks on amputation of the cervix contain nothing new.] Dr. Robert.s,§ in two very elaborate essays, treats of leucorrhea, and of the importance of employing the speculum in cases where it is present, since it is not a mere increase of the vaginal discharge from debility, but is almost always symptomatic of uterine disease, especially of inflammation of the os and cervix, or more rarely of the lining membrane of the womb. The facts on which his conclusions rest, contain nothing new, but afford a confirmation of the statements of most other writers who have made frequent use of the speculum. M. (Jibert|| strongly recommends an alcoholic tincture of tannin, mixed with seven parts of water as an astringent injection in leucorrhea, and in cases of ulceration of the os uteri. Dr. Mitchell1]! speaks of the employment of the actual cautery to the spine as a means of relieving that extreme pain in the back, which attends some of those cases of leucorrhea where there is very great tenderness of the cervix uteri It does not appear that he employs the cautery so as to produce a slough, but that he uses it as a mild counter- irritant, similar in its operation to the rnoxa, though far less severe. Polypus uteri. A paper on this affection has appeared from the pen of Dr. Montgomery,** containing much valuable information. He notices the frequent occurrence of very small uterine polypi, which may not merely escape detec¬ tion on a vaginal examination, but may even fail to be discovered by the speculum, owing to their being situated between the lips of the os uteri. Even these small polypi, however, are a common cause of ulceration and menorrhagia, the eure of which requires, as a preliminary step, the removal of the polypus These small polypi derive additional importance from the eircum- # In the Lancet for the autumn of 1845, and summer of 184(J. t Gaz. lVIed., June, July, August, and September, 1845. % Des Abus de la Cauterisation, et de la Resection du Col dans les Maladies de la Matrice. 8vo. Paris, 1846. § New York Journal, April, July, 1845. II Gaz. Med., Aug. 9, 1845. *[f Dublin Medical Press, Oct. 7, 1846. ** Dublin Quarterly Journal, August, 1846. 2