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substance of the mammary gland. When an abscess is formed here, its prompt evacuation is desirable : but the perception of fluctuation is difficult, for the pus is surrounded by a large mass of tissues, and the thoracic parietes have not fixity enough to serve as a point of support. Nevertheless, you may recognize the existence of pus by the following characters. 1. An acute phlegmon rarely exists more than seven or eight days without suppuration taking place. 2. The breast is raised up like a sponge, and if we press upon it, it seems as if it were lying on a bladder full of fluid. 3. We find the breast surrounded by a kind of inflammatory ædema. Having recognized the pus, we should let it out promptly, or we expose ourselves to seeing it traverse the gland and form one of those ab. scesses I call shirt-buttons. These abscesses, moreover, have a mischievous influence upon the chest, and may lead to a purulent pleurisy. They may, too, penetrate into the cellular tissue for a distance, and give rise to a diffused phleg, mon. The incision should be made into the most dependent part, the place of election being below and at the outer side of the nipple; but, in some cases, a projecting point of the abscess indicates the place at which the opening should be made. It is always advantageous to make the incision towards the circumference of the breast, because the gland itself is not touched, and its weight tends to expel the pus. The bistoury should be directed almost parallel with the thoracic parietes, so as to slide it in between these and the mamma. The danger of such incisions is not great, there being no large arteries to fear. Parenchymatous phlegmon requires an energetic and varied treatment. Bleeding, purging, and the so-called anti-lactal medicines. When pus forms, which is almost always the case, topical applications and incisions seldom prevent the successive implication of the lobules. Nevertheless, there is some advantage derived from the prompt opening the abscess, if the patient agrees to it; for you should recollect that, in practice, if you open one abscess and others form, she never fails attributing these to your proceedings. These details will, I think, suffice to show you how important it is to distinguish the different abscesses of the breast, and to explain to you the confusion which prevails in the minds of some surgeons as regards their treatment.”—Gazette des Hôpitaux, No. 89.
[The above remarks, like all that falls from this excellent surgeon, are well worthy the attention of the practitioner. We have seen much needless suffering caused by the formidable operation of incising through the whole substance of the breast, to get at an abscess situated at its posterior part, and which might have been much more easily reached by the circumferential incision here recommended.—Rev.]
ON THE NATURE OF THE LIQUID SECRETED BY THE Mucous Mem.
BRANE OF THE INTESTINES IN CHOLERA. By M. ANDRAL. M. Andral recently read a note at the Academy of Medicine, giving an account of the researches he has been engaged in for the purpose of determining the nature of the peculiar white matter, resembling a decoction of half-cooked rice, which is found in the digestive organs of patients attacked with cholera, and which especially belongs to and characterises that affection. From the facts detailed he drew the following conclusions:
“ 1. The white matter which fills the intestines of cholera patients is not, as it has often been stated to be, a portion of the blood itself; for neither albumen or fibrine are found in it. 2. It is nothing else than mucus rapidly secreted in large quantities, and for this reason modified in its qualities. 3. T'he essential microscopic character of this matter is its containing a very considerable number of cells, with nuclei perfectly resembling, as far as regards their appearance, the 1847) Induction of Premature Labour in Miscarriage. 545 cells found in pus, although this matter in no other respect bears any resemblance to pus. 4. The examination of the blood of cholera patients shows that the albumen of the serum is maintained in its normal proportions. 5. The theory which refers the symptoms of the stage of cyanosis in cholera to the change which the blood has undergone by reason of a great and sudden loss of serum, cannot be admitted.”—Gazette Medicale, No. 33.
INDUCTION OF PREMATURE LABOUR FOR THE PREVENTION OF
Death OF THE INFANT IN MISCARRIAGE AT THE Eighth Month.
Dr. Secondi proposed the following question for the consideration of the Medical and Surgical Section of the Eighth Italian Scientific Congress, held at Genoa, Sept. 1846. Whether, in the case of several successive deliveries of a dead fætus in the course of the eighth month, it is not admissible in a consecutive pregnancy, to induce premature delivery at the seventh month.” In support of the proposition he narrated two cases observed by him ; one of a lady, who was delivered in eleven successive pregnancies of dead children at the eighth month, although the fætus had continued alive after the seventh, and every means that could be suggested by art, and these of different kinds in the respective pregnancies, had been put into force in order to avert the catastrophe; in the other case, the lady miscarried in this way five times. In both these cases the position of the patients was such as to admit of their adopting every hygienic precaution recommended, their health seemed quite good, and they were taken in labour without any indications of preexisting or present affections, the fætuses and their dependencies likewise not manifesting any signs of disease. Reasoning upon these facts, it seemed to him that these women were governed by different vital laws, either primarily so, or secondarily dependent upon the presence of the fætus, by reason of which the nutritive relations between it and its parent ceased, and it was separated just like a fruit from the tree. As the provocation of premature labour does not compromise the life of the woman, and very little endangers that of the child, he answered the question in the affirmative.
Dr. Arata supported this conclusion, and related two cases in point. In the one, the accident in question had occurred eleven, and, in the other, five times, in spite of the employment of every kind of therapeutical agency; and notwithstanding that the subject of the last case was of a favourable temperament and in good health, and the other, in consequence of a suspected syphilis, had been duly treated. He added that the fætuses possessed a due development, with no indication of disease in them or their dependencies; and that if we induced premature labour on account of a narrowed pelvis, we should do so also in the case in question.
Professor Centofanti, although inclining to Dr. Secondi's opinion, would first wish to learn the cause which prevented the fætus continuing to live after the eighth month, and whether it died really in the eighth month or before. The causes which lead a woman to abort in the eighth month must be either inherent in her own organization, or in that of the fætus or its dependencies. He believed that the causes inherent in the woman, if not organic, may be removed by a properly adapted method of cure ; but that such is not the case with those dependent upon vices of the fætus or its dependencies. Where, too, they depend upon fætal disease, before we can determine whether we can or not prevent the bringing forth a dead fætus, it would be requisite to examine whether these all were de rived from the fætus, or from the special condition of the woman reflected back upon the fætus. Lastly, it is to be recollected that a fætus may die at the fifth or sixth month, and continue to remain in the uterus until the eighth, providing the membranes have not been ruptured : so that the propriety of the operation is
confined to those cases in which we are certain that its death takes place in the eighth month.
Professor Vannoni. We should look at this question in its true aspect; the death of the child. What ought to prevent us endeavouring to save an infant which would otherwise die at the eighth month? And why is the Cæsarian section or symphysisotomy instituted but that the fætus has a right to social life? He considered the question of the cause of the death of the child at the eighth month as one of the highest moment, and besides the recognized organic causes, and the maternal or fætal diseases, &c., he would take into account other -physical-causes. It does not suffice for the explanation of these accidents to invoke a particular condition of the woman. There are other causes on the side of the fætus. We should bear in mind that the fætus, having reached a certain point, can live no longer, although the mother is healthy, and it itself, after expulsion, exhibits no mark of disease: and we must admit here an intrinsic cause which operates within the uterine cavity, by reason of which the fætus has reached such condition of development at the eighth month, as to be already old and unable longer to retain life. When, therefore, the ordinary means are at fault, and a careful diagnosis has been made of the causes which could perchance give rise to this accident, premature labour should be induced. But are we certain, by this means, of preserving the child's life? To decide this we have need of experiments, and in inducing premature labour even in the case of our not succeeding in saving the fætus, we have removed it from the cause of death to which it was exposed.
The Section eventually came to the following decision :—That when, on four or five successive occasions, a woman has been delivered of a dead fætus at the eighth month, it is justifiable in future pregnancies to induce premature labour.— Annali Universali, Volume 121, pp. 172-5.
[This application of the induction of premature labour is new to us, and one of very doubtful expediency. The question of the cause of the death of the fætus in utero is involved in too much obscurity to admit of positive opinions upon many points being pronounced; but it seems to us, when we bear in mind the great difficulty in preserving and rearing premature children, that one whose vital powers were so limited as not to admit of the retention of life in utero, would have its chances of so doing little if at all increased by inducing its more hasty expulsion. Admirable as is this resource in appropriate cases, and foremost as have the practitioners of this country shewn themselves in employing it, the induction of premature labour is not an operation to be extended to additional emergencies with out the gravest consideration and the strongest probabilities of success. Independently of the danger of too hasty a generalization of it in a moral point of view, it is by no means so unattended with risk to the mother as our Italian brethren (prevented by priestly interference from employing it in appropriate cases) would seem to infer.
We may take this opportunity of expressing the great pleasure we have derived from the perusal of the proceedings of the Medical Section of the Congress. Several excellent and learned papers were read, the spirited discussions upon which well proved that the Italian physicians and surgeons were as earnest participators in the progress of medical science as their brethren of any other portion of Europe. This Section seems to have taken a prominence in the proceedings of the Congress pot observed in the scientific periodical assemblages of France and England; which is probably due to the far more rapid diffusion and interchange of ideas which takes place by means of the organs of the medical press in these two latter countries than in Italy—where discussion of any kind is but a thing of yesterday.-Rev.]
Purulent Ophthalmia of Infants.
PURULENT OPHTHALMIA OF New-BORN INFANTS.
M. Chaissaignac, surgeon to the Foundling Hospital at Paris, has recently addressed a letter to the Académie des Sciences, giving some account of the views he entertains concerning this affection, and of the success which has attended his treatment of it by irrigation. Since then, M. Laborie has attentively examined the subject in M. Chaissaignac's ward, and furnished the following account for the pages of L'Union Medicale.
When M. Chaissaignac received his appointment to the Foundling Hospital, he was struck with the great number of children who were suffering, in different degrees, from the consecutive effects of purulent ophthalmia. Attentively examining the disease for the purpose of endeavovouring to prevent the continuance of such calamitous results, he discovered that this inflammation presents a characteristic which has hitherto escaped observers. With very few exceptions, pseudo-membrane was found to be present on the conjunctiva, the removal of which was found much to facilitate the successful issue of the disease. This assimilates the disease to various other affections frequently met with in infancy, such as muguet, diphtheritis, croup, &c. This result, to which M. Chaissaignac's direct observations led him, appeared to us to be beyond all doubt; for we had already remarked during our residence at the Clinique, a remarkable and almost constant coincidence between the appearance of muguet and purulent ophthalmia. So constantly did these affections show themselves one after another that M. Paul Dubois always predicted to us, when he had observed some cases of muguet in the wards, that we should soon see examples of purulent ophthalmia.
In his letter to the Academy, M. Chassaignac reports the great success which has attended his mode of treatment by irrigation, and it will be as well to state what induced him to adopt this, and the mode in which he employs it. Being in charge of the Hópital de l'Ourcine, he had a great number of women under his care who were suffering from vaginitis attended with the most obstinate discharges which every form of the ordinary treatment, perseveringly tried, failed to subdue. Believing this to arise from portions of the mucous membrane which the applications had not reached, constantly secreting a contagious liquid, it struck him that keeping these parts constantly washed might lead to more fortunate results. Since this has been put into force far greater success has attended the treatment by medicated injections, &c.
In purulent ophthalmia, also, the remaining portion of the mucous membrane is much rather affected by contagion than by continuity of surface, and constant irrigation seemed the most effectual means of preventing this through its prompt removal of the contagious matter. M. C. commenced his experiments very carefully, until he had ascertained that the means was positively harmless when not efficacious. The following is the manner in which the irrigation is employed. A reservoir is fixed against the wall at about three or four yards from the ground, having two cocks at its lower part, to which are adapted caoutchouc tubes, with apertures of about 2 millimetres diameter. By means of a moveable diaphragm the force of the stream may be regulated. The child is laid upon a table covered with waterproof cloth, with its head placed against the wall under the reservoir, and slightly inclined backwards, so that the rest of the body is not wetted. The two tubes are brought to a level with the head, and the operator directs the jets first upon the eyelids, then against their edges, and after some minutes, over the entire conjunctiva. The operation is continued for 10 or 15 minutes or longer, and is repeated several times a day. Generally, the child manifests no sign of suffering as long as the eyelid is only watered, and sometimes not even when the interior of the eye is; but for the most part it then complains, and, if the operation is too prolonged, becomes very impatient under it, and cries, so that a suspension becomes necessary. During the operation the eye becomes a little red, and all the secretions and pus are removed from the edges of the eyelids. When the fluid pus has been thus removed also from the mucous membrane, the conjunctiva is found of a greyish aspect, which seems to result from a purulent deposit. But in spite of washing, this does not disappear, and it is in fact the false metabrane indicated by M. Chaissaignac, which, under the influence of the water becomes more opaque. It may be raised and removed without much difficulty by means of a pair of fine forceps. Sometimes no erosion of the surface is left by its detachment, but at others there is all the appearance of a true wound left
. Sometimes the membrane is very extensive, covering all the ocular conjunctiva as well as the cornea. At others it is only partial, being seen at several unconnected points. When the irrigations have been employed and this membrane removed, it is not reproduced upon the same part. Astringent collyria are used during the day, although, since he has employed irrigation, M. C. seldom has recourse to these.
M. Chaissaignac has employed the irrigation in other affections of the eye with advantage, such as obstinate blepharitis. Of 76 patients admitted during the last ten weeks, 40 were suffering from well-marked purulent ophthalmia, 20 from various forms of blepharitis, 7 from papular conjunctivitis, and 4 from old opacity. The duration of treatment has, for the purulent ophthalmia, occupied a mean period of 10 days, for the conjunctivitis 4 or 5 days, and for the blepharitis 3 weeks. In no one of the cases of purulent ophthalmia did the cornea becoine affected.
M. C. does not attribute to the irrigation any great special medicatory power, it being, in fact, chiefly a hygienic measure for the removal of the abundant discharge : and collyria are employed while resorting to it. But under its influence the false membrane becomes more easily visible and consistent, and consequently more easily detached; the removal of this, which acts upon the eye with all the injuriousness of a foreign body, expediting the cure and rendering it more certain. The application of cold also, of such utility in other inflammations, doubtless has a beneficial effect in this.
In appreciating the success of this treatment we must not, however, overlook that also derivable from other procedures ; thus, we have not met with a single case at the Clinical Hospital, during two years, which did not yield to the following means, viz. a collyrium of nitrate of silver (32 parts Aq. dest., to part Nit. Arg.); a slightly emollient collyrium frequently during the day; great cleanliness of the parts to be secured by preventing the morbid secretions rernaining in contact with the eye. In very rare cases a slight application by means of a pencil of nitrate of silver is made to the inner surface of the eyelids. M. Paul Dubois says he has never known an eye to be lost under this treatment.
We have already stated that M. Chaissaignac has treated several cases of blepharitis by irrigation with great success. Several of those we examined were examples of ciliary blepharitis, and the obstinacy of this disease is well known. A circumstance which contributes to the tediousness of cure is the manner in which the secretion from the Meibomian glands glues the eyelashes together, forming them into hard brushes which simple lotions can scarcely render supple
. By means of irrigation, which produces no painful or disagreeable sensation, they are freed in some minutes from all concretions. They become supple and no longer stick together.
M. C. likewise believes that staphyloma may be advantageously treated by irrigation. He does not pretend to say it may be so cured, but, under the use of this means, he has observed a positive arrest in its progress, and sometimes even a slight diminution of the projection. The douches in this case seem to exert a resolvent and tonic effect. --L'Union Medicale, Nos. 108-109.
[When M. Chaissaignac's letter was read at the Academie, M. Flourens took