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This work which appeared in the Medical News last year, has been issued in a neat volume. It treats of
Ruptured Perineum, Prolapse of the Vagina, Prolapse of the Uterus, Vesico-Vaginal Fistula, Recto-Vaginal Fistula, Lacerated Vagina, Polypus of the Uterus, Stone in the Female Bladder, Vascular Tumour of the Meatus Urinarius, Imperforate Hymen, Encysted Tumour of the Labin, Diseases of the Rectum resulting from certain conditions of the Uterus, On Ovarian Dropsy or Encysted Dropsy of the Ovary.
Each of these subjects is treated of in a clear, concise, and authoritative manner. The author tells of what he knows, rather than of what is known by others. As an example of the style of this book, we copy entire his article on
“PROLAPSE OF THE UTERUS.” “Of this affection there are three varieties, which, according to the description of my respected teacher, Dr. Blundell, are respectively called, Procidentia, Prolapsus, and Relaxation of the Womb. Several examples of these varieties of prolapse are recorded in the chapter on Ruptured Perineum, with which lesion they were associated, and of which they were doubtless in a great measure the consequences.
I. Procidentia Uteri is said to exist when there is complete prolapse, with protrusion of the uterus beyond the vagina. It is consequently the severest form of prolapsed uterus.
Causes.—The immediate causes of this disease are :
This displacement consequently appears in subsidence of the uterus from deficient support, either from above or below. Such a want may arise from various causes originating in the general health of the patient, in local affections of the uterus, and in mechanical injuries.
One most common cause is the too early adoption, or too long continuance of the erect posture after delivery or miscarriage, before the uterus and its connections have recovered themselves in position, size and tone; i. e., speaking generally, before the end of the third or fourth week. Again, à violent cough at, and after labour, tends to thrust down the uterus by the strong action of the
diaphragm in the act of coughing, when too the vagina has not recovered itself and can render little support.
Single women, however, are not exempt from this accident, and in them mostly, from the nature of the causes, cure is more difficult to effect.
Symptoms.—One of the first symptoms of procidentia uteri is pain in the back, succeeded by some in the groins and labia, in which also there is a feeling of fulness. The pain in the back soon assumes a dragging character; there is a sensation of bearing-down or of weight, " as if” (as patients will describe it) “ everything were dropping through.” Together with these symptoms there are an increased mucous discharge from the vagina, often a frequent desire to micturate, and sometimes a degree of stangury, irregularity of the bowels, and interference with the process of defecation, sympathetic disorder of the stomach, loss of, or capricious appetite, dyspepsia, distension of the abdomen, &c.
With the pain and other local evils, and with the general bodily disorder, it is not to be wondered at that the spirits flag, that every occupation becomes tiresome, and life often times a burthen,
Diagnosis. With a little care, the os uteri may, by manual examination. be detected, and by observing its position and relations, our diagnosis may be readily made from polypus uteri, and from either variety of vaginal prolapse.
Treatment. For a long period, in the progress of most cases, the uterus returns of itself or otherwise is easily replaced, on the patient assuming the recumbent posturt. Hence in the early stage, this posture, with the hips considerably elevated, must be insisted on, and continued for a long time; attention being at the same time given to maintaining perfect quiet. The food should be unstimulating, and opium administered by the mouth to prevent the action of the bowels, and so to keep the parts quiet; injections, however, being occasionally used. So soon as all inflammatory symptoms have subsided, cold, astringent and stimulating injections may be employed; the cold douche over the abdomen is especially beneficial. At the same time the system generally requires to be braced by tonics, change of air, and good or generous diet. Let the introduction of pessaries be avoided. I will here state my objections—and they apply to each variety of prolapse, whether of vagina or uterus -to pessaries of all forms, as mechanical supporters. As a general rule they are bad; they are prone to produce irritation and excori. ation, and with these leucorrha; they are incompatible with perfect cleanliness; and they stretch and tend to keep up the relaxation of the canal. To afford local support I find nothing so useful as the form of perineal bandage which I devised and described some years back, and have constantiy used. Should these measures auxiliary to to the efforts of nature in recovering the normal tonicity and status of the parts be unsuccessful, or should the diseased condition have been previously neglected until no longer amenable to medical treatment, then we may seek a cure by surgical means.
The measure I propose resembles in principle the one I have adopted in prolapse of the anterior and posterior walls--viz: in mechanically curing the displacement by contracting the relaxed, loose mucous canal. With this object I suggest the removal of a portion of mucous membrane anteriorly, posteriorly, and laterally, and the introduction of sutures after the same plan as in the other operations. A similar course of proceeding appears called for in those very rare instancer of prolapse of the entire vaginal canal without procidentia uteri.
Such a condition is spoken of as a distinct one by Dr. Churchill, who quotes a case recorded by Noel, where the prolapse reached the knees. But a relaxation of the vaginal walls seems almost necessarily to entail a more or less complete subsidence of the uterus, when, according to the accepted nomenclature, we should rather refer to the condition as one of prolapsed uterus than of prolapsed vagina. However this may be, the general treatment would be the same.
II. Prolapsus Uteri.—Resembles procidentia in all points but in the extent of displacement, which does not proceed beyond the canal of the vagina. It is of more common occurrence than procidentia. The symptoms attending the two conditions are alike, except that in procidentia they may present greater severity. Moreover, the causes and general treatment are similar, and need here no detail. It seems almost unnecessary to add that, as in the last accident, I object to pessaries. Unless the perineum be much dilated, and have lost its usual tonicity, I should confine myself to the use of the perineal bandage to support it, and to obviate the pressure of the uterus upon it; but if much dilated, I should attempt to restore its natural supporting power by contracting it and the dilated vagina, by removing a piece from the centre of the perineum, dissecting back the mucous
membrane over the recto-vaginal septum, and bringing the edges together by sutures.
III. Relaxaticn of the Uterus. This is the least degree of displacement of the viscus. It implies merely a subsidence of the womb from debility of its structures—its attachments or, so-called, ligaments, and of the vagina. It is very open to general medical treatment, associate attention to the umbent posture, avoidance of fatigue, straining, &c., and proper hygienic conditions.
In this slight form surgical measures are not called for.”
ON THE TREATMENT AND PREVENTION OF CONSUMPTION, AND INCIDENTALLY OF SCROFULA. With a Demonstration of the cause of the Disease. By HENRY McCormac, M. D. London. Published by Langman, Brown, Green, and Langman. pp. 111.
Starting with the assertion that “ Consumption and Scrofula in all essentials are one,” the author takes the common-sense view that they depend upon constitutional depravity. He believes that Tubercle “is a foreign body, a body that has no business to be present, obtruding itself instead of, in and upon, the natural fluids and tissues, but when present more especially in the lungs, constituting phthisis, or in other words, consumption of the lungs.”.
This is an excellent little book, and we hope it may be reprinted in this country.
Dr. H. D. BULKLEY, formerly editor of the N. Y. Medical Times, has become associated with Drs. Purple and Smith, of the N. Y. Journal of Medicine, which is one of our best medical periodicals. By this union both journals become consolidated.
THE COLLEGES.—Dr. L. M. Lawson, who recently resigned his professorship in the Kentucky School of Medicine, has been elected to the Chair of Theory and Practice of Medicine in the Medical College of Ohio. In the same school Mr. E. S. Wayne, an experienced analytical and practical chemist and pharmaceutist, has been appointed Lecturer on Practical and Experimental Chemistry. This is a capital idea, and the appointment, we should judge, a worthy one. We wish other colleges would follow the good example set by the Medical College of Ohio.
Dr. Middleton Goldsmith, for inany years Professor of Surgery in the Castleton Medical College, Vt., has been appointed to the Chair of Surgery in the Kentucky School of Medicine.
Dr. E. Andrews has resigned his position as Lecturer on Comparative Anatomy and Demonstrator in Rush Medical College, Chicago, Ill.-Med. Reporter.
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