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however, pass them over altogether without noticing briefly a very in teresting case, related by our author in illustration of this point.
A young woman, in the advanced stage of pregnancy, fell off the chair on which she was sitting at work, and, after two or three deep-fetched respirations, expired. In the course of about four minutes from the time of the fatal event, Dr. Campbell, an interne of the Maternity, ascertained that life was quite extinct: there was no respiratory murmur to he heard, nor any pulsation of the heart. In the report of the case, communicated by this gentleman to our author, the following particulars are given :
“ Immediately after the death of the mother, the presence of a living child in the uterus was ascertained; the pulsations of the fætal heart were distinctly heard, their number being from 120 to 140 in the minute.
“ While I was examining the chest of the mother, my hand, resting on the abdomen distended by the uterus, felt some active movements: the shock was pretty strong, brusque, and repeated at short intervals. Auscultation enabled me at this time-about six minutes after the death of the woman-to detect the sounds of the fætal heart in the left iliac fossa: they were regular, tolerably strong, and did not exceed about 100 in the course of the minute. Two or three minutes subsequently, they had fallen down to between 60 and 80.
“ The circumstance of the rapid diminution of the fætal pulsations, added to the brusque character of the active movements of the fætus (a truly pathognomonic character of compromised vitality) on the one hand, and, on the other hand, the certainty of its almost immediate death if something were not done without delay, induced us to have recourse to the Cæsarian section, which was commenced ten minutes at least after the death of the mother. The child, although living when extracted, did not make an inspiration until 25 or 30 minutes had been spent in insufflation by means of a laryngeal tube. It was only when a large quantity of amniotic fluid had been rejected by the mouth, nose, and the tube itself, that it began to utter a few feeble moans; nor was it relieved from the state of general cyanosis and insensibility, before a small quan. tity of blood was allowed to flow from the divided end of the cord. It is now fifty days old, and seems to thrive very well.”
From the consideration of this and such-like cases, as well as from other circumstances (of which one of the most remarkable is the fact that, while the inhalation of æther has the uniform effect of accelerating the pulse of the mother, it scarcely, if at all, affects that of the fætus), Dr. Depaul is of opinion that it may be fairly regarded as proved that there is no direct connexion between the maternal and the fætal circulation,--that derangements of the former will sometimes persist for a considerable time without reacting in any manner upon the latter ;-that nevertheless, when these derangements are of a nature to produce profound modifications, inappreciable though these may be by their physical characters, in the blood of the mother, they exert an influence, after a variable time, upon the fætus, and this influence is evidenced first by an increased frequency of the fætal pulsations, and then by a diminution of their frequency, which is a sign of much more serious import;- lastly, that the moral emotions of the mother can act upon the child only consecutively, and through the intervention of the blood."
In reference to the 18th proposition, the following details will be read with interest. In 17 out of 26 cases, in which the period of pregnancy was from the end of the third to that of the fifth month, and in which our author could detect no fætal pulsation, the result proved the correctness 1847] The Cardiac Pulsation of the Fætus.
505 of his diagnosis. In the majority of the remaining cases, the pregnancy had not exceeded the fourth month. As to the cases, he adds, in which he had once heard the sound, the negative result obtained subsequently never misled him : the death of the fætus was always demonstrated ultimately.
Out of 67 cases, in which the women were in the four last months of gestation, the absence of the fætal pulsations, taken as the evidence of the death of the child, disappointed our author's diagnosis only on three occasions. He very properly reminds his readers that, in order that the examination may be regarded as conclusive, not only must the physician have had
very considerable experience, but the exploration also must have been repeated on several occasions on two or three different days.
There is a case reported by M. Naegele, in the Medicinische Annalen for last year, that bears upon the proposition 20: it is entitled, Results furnished by Auscultation in a case of Triplets. A woman, in labour with her first child, was ausculted by M. N., who found in the left hypogastric region the double beat of the fætal heart, as well as a simple blowing sound of the umbilical cord, and in the right hypogastric region two other double pulsations. Upon two observers examining with the stethoscope, one on each side, at the same time, it was found that the beats of the fætal heart and of the cord were rather more frequent on the right than on the left side (152 to 144). Subsequently, after the right fætus had been in brisk motion, the heart was found to give 160 beats, and the cord only 144 ; there was thus a difference of 16 beats in the minute. After the delivery of a first child, auscultation was again practised ; and still the pulsations of two hearts were heard distinctly, the one set in the left hypocondriac, and the other in the right umbilical, region. The head of the child, which next presented in the vagina, was found to be in the second position; consequently the cardiac pulsation on the right side belonged to it. After its expulsion, the fætal pulsations, indicating the presence of a third child, were still readily to be heard : this child was born without the assistance of art.
Although the presence of three children was only made out after the birth of the first one, the case still serves to shew how much information auscultatory means are capable of affording. It should be mentioned that there was no appreciable difference in the uterine souffle, either as respects intensity or the extent of space over which it was perceptible.
Had our space permitted, we might have felt inclined to have given, at some length, an abstract of Dr. Depaul's observations as to the possibility of ascertaining the position of the fætus in the womb by attending to the exact spot where the tictac is loudest, and where, consequently, the heart of the child is situated. All that we can do is to make one or two very short extracts from his elaborate narrative.
After alluding to the inapplicability of the test in question in the first five or six months of gestation, in consequence not only of the insufficient development of the uterus, but also of the small dimensions of the fætus and its extreme mobility in the liquor amnii, he goes on to say :
“ But at seven months the relations of the child to the uterus are much less variable; the great axis of the child has, from this time, such dimensions as rarely permit one of its extremities from taking the place of the other. The movements in the line of this axis are somewhat more frequent and more easily anderstood ; but these become more rare as the full period of gestation approaches, so that at the end of the eighth month they are mere exceptions which are very seldom met with.”
Still, however, cases do occur, where the child seems to have made a complete somerset within the uterus, at an advanced period of pregnancy, Allowance must therefore be made for such occasional occurrences. I:n
To understand the following remarks, let the abdominal uterine globe be supposed to be divided into four parts by a transverse line passing a little below the umbilicus, and crossing a perpendicular one drawn from the epigastrium to the pubes.
“When the fætal pulsation is found in the left inferior region, the presentation will be that of the head, and the back of the child will be turned towards the left side; when in the right inferior region, the presentation will be the same, and the back of the
fætus be turned to the right; when, on the contrary, the sound is heard in the left superior region, the pelvic extremity will be the part most depending, the back being turned to the left; when in the right superior region, the position will be the same, with the exception of the back being directed to the
With the view of rendering his observations on this hitherto little-explored subject of obstetrical enquiry better understood, our author has in troduced several illustrative wood-cuts representing the relations of the fætus in different positions in the pelvis.
We need scarcely say that we think very highly of Dr. Depaul's volume, and that we recommend it in the strongest terms to the attention of the profession in this country.
13 oli bar by 701 cool sds ga: 18 ON THE SYSTEM OF THE GREAT SYMPATHETIC NERVE. First
Part. By C. Radclyffe Hall, M.D. Republished from the Edinburgh Medical and Surgical Journal.d847. odtwa adT
Tada si noi gaey simladigo da sad! An additional attempt to solve the enigma of the Great Sympatheticis not & very promising topic for the generality of medical readers. We have, however, no wish either to underrate the importance of the subject or to depreciate the merits of Dr. C. R. Hall's memoir ; but if this paper had not been brought more directly under our notice in the shape of a separate pamphlet, it might, without any injury to science, have been left in the pages of the periodical in which it originally appeared, for the cepsideration of the professed physiologist, to whose acumen the experiments and reasonings of the author are more particularly suited. A few extracts will enable our readers to understand the general views here promulgated; those who require more minute information, must refer to the work itself.
We have always ourselves selected the cephalic ganglia as the type of the great sympathetic; because here, as in so many analogous instances, Nature has offered for our investigation an analysis of what, in other parts of the same system, is obscured and involved. For instance, in these scattered ganglionic masses the observer, owing to the natural severation
Actions of the Pupil.
of the motor and sentient elements of the cranial nerves," which in the case of the spinal nerves are bound up together, is enabled to detect -a fundamental fact connected with the sympathetic, namely, that its ganglia receive from the cerebro-spinal system both motor and sentient branches ; he can further perceive that each of these isolated nodules of gray matter is brought into anatomical relation with the rest of the sympathetic by special filaments of communication, often running a long and tortuous course to effect the junction. Similar reasons, joined to the comparative facility of access and to the ease with which the results of experiment produced on the eye can be observed, have induced Dr. C. R. Hall to choose the ophthalmic ganglion for investigation-"the lenticular ganglion represents the ganglionic system in miniature; what can be proved with respect to it, may justly be taken as a safe index of the rest.
The following observations on the varying states of the pupil are worthy of attention:
“ The pupil after death in every animal is of the medium size natural during life. The exceptions are numerous, and depend upon the state of the iris at the time of death, and upon the action of external agents after death. If the pupil is very large when death occurs, as in slow death from banging, or prussic acid, it will retain this size for some time after death; as the body cools, the pupil lessens, but is seldom reduced to the medium size. But when death from prussic acid is instantaneous, the largely dilated pupils will contract in a few minutes after death to less than the medium size, and afterwards enlarge again. The varying degree of contraction of the sphincter iridis at the time of coagulation of the blood, (which does take place, at least in small vessels, after poisoning by prussic acid,) may perhaps account for this. If death occurs with the pupils contracted, these enlarge after a time, but do not generally attain the ordinary medium size. In practising operations on the eye of the human subject after death before the animal heat has vanished, a dilated pupil always contracts as the aqueous humour escapes. This, like the motion of a narcotized iris in extracting the lens for cataract, and like the contraction of the previously dilated pupil of a drowned kitten on exposing the animal to the heat of a furnace, in an experiment performed by Haller, is probably due to physical influence.” P. 3.
The author has corrected some errors of former anatomists, such as that the ophthalmic ganglion is absent in the rodentia ; on the contrary, he found it beneath the optic nerve, but so minute as to require great care in the dissection, in the rabbit, squirrel and guinea-pig. The conclusions drawn from the various experiments upon the ophthalmic ganglion and the nerves connected with it are thus set forth :
"1. The third nerve is the only direct motor nerve for contraction of the pupil in dogs and cats.
“2. The action of the third nerve, as far as concerns the iris, is inainly under the controul of the visual nervous tract.
“ 3. As both the third nerve and some portion of the visual tract must inevitably be injured in performing the experiment of dividing the fifth nerve after Magendie's plan, the experiments of that gentleman cannot be considered as evidence that the fifth nerve is either directly or indirectly the nerve which presides over dilatation of the pupil in dogs and cats ; nor over contraction of the pupil in rabbits and guinea-pigs.
de 4. In animals in which division of the fifth nerve causes contraction of the pupil it does so by excito-motory action through the sixth nerve, which in these animals supplies the iris in conjunction with the third. The sixth nerve, how. ever, not entering into the formation of the ophthalmic ganglion, which in these animals is extremely small.
“ 5. In these rodentia, pain of any kind, whether produced by irritation of the fifth, or of any other sensational nerve, will cause more or less contraction of the pupil at the instant, attributable probably to excito-motory action of the iridal fibres of the sixth nerve.
“6. Irritation of the fifth nerve, or of any other sensational nerve, in the cat, and dog, and pigeon, so long as it does not affect the brain to the extent of producing vertigo, nor the visual sense in any other way, has no immediate influence over the size of the pupil. Hence, although the fifth is an excitor nerve to the sphincter iridis in the rabbit, it is neither directly an excitor nor a motor nerve to it in the dog and cat.
“7. As the third nerve can always, under favourable circumstances, be made to influence the movement of the iris, immediately on the application of irritation, and as the iridal portion of the third nerve, in all animals in which the iris is active, passes through the ophthalmic ganglion, it follows that the ophthalmic ganglion offers no check to the transmission of motor influence along the motor nerve fibres which pass through its substance.
“8. As irritation of the fifth nerve does not in any animal affect the action of the iris after division of the cerebral connections of all the other ocular nerves, and as some portion of the fifth nerve always enters into the ophthalmic ganglion, it follows, that the filaments of the fifth nerve have not the power of affecting those of the third nerve during their course together through the substance of the ophthalmic ganglion ; or, in other words, that the lenticular ganglion is not a centre of excito-motory action to the iris." P. 25.
Some interesting cases are related with the object of showing that, although the fifth nerve, as we have seen in the above extract, is neither a motor, nor, with some exceptions, an excitor nerve to the iris, yet that it does in some way so affect the internal structures of the eye, as to influence the state of the pupil, inducing under some circumstances contraction, and under others dilatation. The author offers, as a mere hypothesis however, the following as the explanation. “It is allowable to conjecture that the small supply of fifth nerve which enters into the lenticular ganglion, passes through to the retina exclusively; that when in the gan. glion, it can affect, during its own conduction of nervous force, the action of the ganglionic vesicles, and consequently call forth the influence, be that what it may, of the ganglionic nerves. Begging the question for the moment, that one effect of the ganglionic influence is the afflux of blood to the part, we can understand how the stimulation of the retina by intense light may cause not only instantaneous contraction of the pupil through the third nerve, but also an altered state of circulation through the retina, through the medium of the fifth nerve, lenticular ganglion and ganglionic nerves, producing painful confusion of sight, or in other words, dazzling and aching in the eye. The unusual supply of blood furnishing at the same time the means of recruiting the over-excited retina. We can understand how one amount of stimulation of the fifth nerve may have such a slight effect on the vascular coat as may merely stimulate the retina, and thus cause contracted pupil (e. g. ulcer of cornea, strumous ophthalmia): how a greater amount of stimulation suddenly applied, or the same amount greatly prolonged, may cause so much disorder of the retinal capillaries, as to produce temporary blindness and dilated pupil (e. g. severe tic). The