THE
CALCUTTA
MEDICAL SOCIETY.
The Fifth Meeting of 1882 was held at the Medical 10th May ; Dr. Harvey presiding. on
College
Wednesday,
Dr. Cayley exhibited two cases in which he had perihe particulars of formed an operation for Trichiasis, the cases and a description of the operation are as follows : CaSe I? J., an European male set. 23, from Dinapur, was admitted into the Eye-Infirmary on 27th April 1882, with of both upper eyelids. On adEntropium and Trichiasis are found incurved in both mission, many of the eye-lashes the eye-ball caused haziness of eyes, and by rubbing against cornea with superficial ulcerations. For the last 6 years he has been suffering from weak eyes, and 3 years ago had a bad attack of purulent ophthalmia, which was followed by growing in of the lashes. An operation for Trichiasis was performed under chloroform on the 28th April 1882. The external commissure Desmain's forceps were applied having been divided by scissors, incision was made along the the upper lid-and an on the ocular side of the bulbs of edge of the lid behind or the lashes and splitting the cartilage to a depth of nearly ith inch. An ovoid flap of skin was then dissected off from the outer surface of the lid of about i inch broad in the centre and of the orbicularis near the edge some of the muscular fibres scissors. The edges of the skin of the lid were shaved off by fine silk suture. In this method wound were then united by the cutaneous edge of the lid containing the lashes,?and the to carry the first incision, which greatest care must be taken the hd, quite behind the roots of ALL of the edge along goes the lashes, or one lash left behind may reproduce all the misfrom the eye, and fixed in its chief?is turned quite away whilst at the same time the connew or natural direction, lid is not injured, and no after junctival surface of the cicatrix or contraction is left theie. In many cases where I have performed the operation the after results have been most perfect, and no outward left. deformity or unsightliness is The In the 2nd case the operation was similar to the first. left eye was operated on on May 3rd. The right eye, which is lemains to be done. very slightly affected, still Both patients were carefully questioned and examined by several members of the Society. The reposition of the lashes The cornea: were clear, and the patients acwas complete. that they had derived great comfort and
under?
knowledged
relief from the operation. Dr. Cayley also exhibited the case of hernia which he had referred to at the previous meeting. This man had suffered from a strangulated hernia of the right side 4 years reduced by operation ; but no attempt ago which had been radical cure ; on this occasion the was made to obtain a on strangulated hernia existed a the left side and the sac and pillars were dealt with with view to a radical cure as stated The wound has now healed ; there is a at the April meeting. of and considepressed cicatrix at the site it. the external ring The scrotum is of natural derable induration beneath cord somewhat thickened, canal adherent to it, and no
size,
impulse
on
to descent.
reducible.
standing
or
coughing, nor any apparent tendency opposite side is scrotal but
The hernia on the .
,
.
,
,
,
Dr. Raye related a very interesting case in which he had been obliged to operate for an irreducible hekjua, and after-
164
THE INDIAN MEDICAL GAZETTE.
wards took the opportunity of performing an operation for the radical cure of the rupture. The particulars of the case are as follows :? Kangali Das, a Hindu male, ajt 40, grocer by occupation, and resident of Sealdah : a healthy robust man, admitted into the 2nd Surgeon's ward, Medical College Hospital, on the lGth April 1882, with a large scrotal liemia of left side and double hydrocele, both of nearly five years' duration. The gut is said to have descended into the scrotum at frequent intervals despite the truss, which was constantly worn : the gut on each occasion used to be pushed back by the patient himself. Condition on admission. ?The tumour was about the size of an adult's head, irregular and somewhat rounded in shape ; testicle could be felt distinctly in the upper and back part of the tumour, which had a soft doughy feeling in front and below with a at the upper part. tense feeling The hernia seemed to be in part omentum and in part bowel. There was also a large hydrocele. Symptoms of strangulation had existed for about twelve hours. The patient was operated on about four hours after admission. The hydrocele was first tapped by a small trochar when about 1? pint of hydrocele fluid escaped ; next the patient was chloroformed ; taxis tried for ^ of an hour, but in vain : an incision about 3 inches long was then made along the axis of the tumour ; skin and superficial fascia divided ; the constriction at the neck of the sac was then divided guided by a director ; next the sac was explored right around and the hernia reduced without opening the sac. Immediately after the gut and omentum had been returned into the .abdomen the sac filled up tensely with peritoneal fluid. The lower part of the sac was then seen to be of old standing, and its upper portion thin transparent unaltered peritoneum, evidently a recent descent. Finding it impossible to keep the sac empty, it was determined to dissect it out, tie its neck and remove it, and thereafter bring the pillars of the ring together with catgut. The original incision was extended down on the scrotum, the sac separated from the surrounding tissues with great difficulty owing to its extreme thinness, keeping the spermatic cord out of the way. A strong catgut ligature was next placed round the neck of the sac, which was nipped off by a pair of scissors ; the stump 'thus formed was allowed to fall back into the ring. As the pillars were about to be brought together a gush of peritoneal flnid escaped from the canal, and on drawing down the stump of the sac it was found that the ligature on it had given way, laying open thus the peritoneal cavity. At this moment the abdomen became suddenly distended with air drawn in no doubt at the instant the ligature on the neck of the sac had given way. A fresh ligature was applied and the operation completed by passing two stout catgut ligatures through the pillars and conjoined tendon. The skin ?wound was closed by metal suture. The patient seemed much relieved after the operation ; had no rigor till the 19th ; the temperature ranging from 99? to 100*. The abdominal wound healed partly by the 1st intention, but the cavity left in the scrotum after the removal of the sac suppurated ; counter openings had to be made at various dates ; and at length the whole scrotum was laid open and made to close by granulation. Beyond these accidents, the progress of the case was uninterruptedly satisfactory, and the patient is now convalescent. It is interesting to note that the freshly descended peritoneum bore with impunity somewhat rough handling, also the manner in which the sac became distended with fluid when its own contents were returned ; how to treat this occurrence was somewhat puzzling ; short of the radical method adopted, tapping the sac might have been employed, but as the peritoneal cavity contained a good deal of fluid this measure would scarcely have been effectual. Can the accidental escape of the peritoneal fluid have been actually advantageous to the patient? The peritoneal cavity, it is to be noted, got distended with air, but no peritonitis resulted. The operation was performed under spray and antiseptically ; Dr. McLeod, who frequently adopts this modified method of the radical cure, being present, and kindly
assisting.
Dr. Harvey remarked that the case just related seemed to fall in with Dr. Marion Sims' views regarding the impunity with which the peritoneum could be handled under certain
[June 1,
188L\
circumstances.
The harmlessness of the entry of atmosair into a healthy peritoneum was also illustrated. Dr. McLeod referred to cases of emphysema and pneumothorax consequent on broken ribs and the absence of any inflammatory or septic mischief in such cases. Since the last had he another case of hernia meeting very interesting which he would relate.
pheric
Kawajut, a Mahomedan aged 45, was admitted into hospital on the 5th of April at 3 P. M., with an irreducible inguinal hernia of the right side. It had been down since 10 A. M.?5 hours. He had only noticed the rupture a fortnight ago. He had also a large hydrocele on the right side and some elephantoid thickening of the scrotum. There were no symptoms of strangulation ; no vomiting or sickness. He had had a motion in the morning. The rupture was reduced the same evening after the application of ice and administration of opium. He was kept under observation till the 9th, when his intestinal functions being normal and general health good, an operation was performed for the cure of the scrotal tumour, hydrocele and hernia. The thickened part of the scrotum was removed ; the skin of the penis which was healthv being left. The hydrocele was then emptied (it contained 8 oz. of fluid) and the tunica cut off close to the testicle. There was a small hydrocele on the left side which was similarly dealt with. The right tunica was extremely thickened and the testicle flattened and wasted. The cord was very voluminous, and its veins varicose. The sac of the hernia was then sought for, found, dissected out, ligatured with three catgut loops atIt the neck, the stump seemed to be an old reduced, and the rest amputated. and adherent to the canal sac, and was somewhat thickened and cord. The pillars and conjoined tendon were then thread which was passed brought together by a double catgut to the spine of the pubis by means of a hernia needle close The cord. thus the outside of loop formed and on the inside on the pubis. The ends was felt to clamp the cord somewhat Pockets were now made in the were left long for drainage. perinseum for the testes which were stitched together in the usual way, the remains of the scrotum being brought over them by a continuous catgut suture. The tumour weighed 13 oz. The operation was performed antiseptically and to the wound in the usual an antiseptic dressing applied took place blood of Considerable oozing during the way. ; temp. 1003. The day necessitating change of dressings Next bladder was relieved by catheter. morning (10th), the He had been very restless, temperature had risen to 101.? On and was still unable to pass water. exposing the cord and right testicle had wound it was found that the lost their vitality. They were therefore freed by cutting and after them, the cord had which secured the stitches been tied by a thick catgut thread, the whole mass was vessels was found amputated ; the blood in the spermatic to have become coagulated. The testis was livid and tore The dressings were reapplied. The asunder with ease. second operation caused some shock, and the temperature Some bronchial irritation was rose to 102'8? in the evening. _
A detected. On the 11th, some cedematous lnnitratioll of the groin and the noticed ; temperature fell upper part of the thigh were to 101?. He was more comfortable next day ; made water. was putrid ; temp. The cedema had spread and the discharge 100?. On the 13th suppuration was detected along the course after castor stool oil; the abscess of the right cord. Had one in the groin became so evident on the 15th that a free counter from 101? to 103.c opening was made ; temperature ranging Has bronchitis. From this time matters went on satisfactorily. The abscess was drained through tubes. A symmetrical abscess was opened on the opposite side. The left testicle adhered kindly to the skin and perinaeal wound had gradually got enveloped in granulations ; the foetor of the discharges abated [and now (27th May) nothing remains but a small ulcer on the right side of the scrotum at the foot of the penis. The sinus resulting from the left abscess closed rapidly, that of the right side more slowly. There is no sign of the return of the hernia, and his general health is good]. This man might be said to have undergone four serious of a scrotal operations in 2 days, namely (1) removal tumour ; (2) laying open of 2 hydroceles and removal of the tunicfe ; f3) amputation of the hernial sac and approximation of the pillars,' and (4) castration. He was somewhat them, but never really in danger. The case convey.
upset by
June 1,
REVIEWS.
1882.]
ed a good practical lesson?not to enter the needle too close to the spine of the pubis. Dr. McLeod had seen gangrene of the cord and testicle result from this cause in 3 other cases.
Dr. Harvey showed a foetus which he had that day removed from a dwarf by Cephalotripsy. The woman was 3 feet 8 inches high. It was her first pregnancy, and she was at about the 7th month of utero-gestation. She belonged to a family of dwarfs. Her father was a dwarf and her sister. The latter had been delivered by forceps at the 7th month by Dr. Charles in the Medical College. She lived for 2 or 3 years after that. This patient had been in labour 80 hours ?when she was admitted. She was in the 2nd stage ; the membranes having ruptured at 9 A. m. that morning. The child had been dead some time. There was a caput succedaneum low down, and the head was jammed at the brim. The external conjugate diameter of Beaudelocq measured 5| inch. Assuming the thickness of the sacrum to be 2J inches and of the symphysis i inch, this left an available conjugate of 2? in. Patient was very low ; pulse 128, respiration hurried ; temperature 100?. The choice lay between the Csesarian section and and looking to the low state of the patient and the fact that the child was dead, the latter was selected.
cephalotripsy,
The head was broken up an(l crushed, the eyes being squeezed out. The thorax was opened in two places, and after
delivery of the arms extraction was accomplished. The placenta came away an hour after. Patient was very low, and no hopes of her recovery were entertained. Baboo Rakhal Das GHOSE had seen a case of cephalotripsy performed by Dr. Charles in 1873. The woman died. The adjourned discussion on the use and abuse op Quinine in pevep- was opened by Dr. Harvey, who remarked that his own experience did not cause him to dread the ecbolic action which quinine was reputed to possess. Dr. Albert Smith of Philadelphia had propounded the doctrine that quinine had no power of originating uterine contraction, but that it had the power of increasing them when
'
otherwise aroused. He was inclined to accept this doctrine. He could cite the case of a lady seven months' pregnant who had taken 30 grains of quinine in one day for hemicrania. The drug had no effect on the uterus. The same patient took 3 10-grain doses of quinine in one day four days ago, without any harm resulting. In another case he endeavoured to cause premature labour by giving 30 grains of quinine daily for 4 days. Nothing occurred. The patient was then fed on raw pineapples, which were reputed abortifacients, for four days without result. Finally labour was brought on in the usual way. At the same time he was in the habit of giving quinine cautiously to pregnant women. He had known uterine pains induced by quinine, but never abortion. He had found that when given in pill, quinine was not so apt to produce uncomfortable effects. The pills must however be freshly made. Baboo Lall Madhub Mookerjee was in the habit of giving quinine to pregnant women, when it was otherwise indicated, to the extent of twenty grains a day without any bad consequence. There was among natives a prejudice against giving medicine of any kind, to females when they were in the family way. Mr. Wallace referred to the observations of Dr. Simmonds of Japan, published in an American paper, which went to show that quinine was specially dangerous from the 3rd to the 5th mouth, and when the system was lowered from other causes. Moulvie Zuheroodeen Ahmed had served in Burdwan during the epidemic of 1871-2-3. There was an attendance at his dispensary of some three or four hundred patients a day. The daily consumption of quinine was about 1 lb. Amongst the patients hundreds of pregnant women came, and he does not remember one single instance in which abortion was caused by the administration of quinine. He did not agree with Baboo Rakhal Das Ghose about the uselessness of quinine in chronic malarial fevers. He had used it largely in such cases?giving it in 2 grain doses twice or thrice a day. It certainly seemed to reduce the size of the liver and and remove, the fever.
spleen
Dr. McLeod had found the addition of hydrobromic acid to quinine obviate the uncomfortable effects on stomach and head which the drug sometimes caused.
165
Dr. Raye had observed that the same combination rendered the phenomenon of tinnitus aurium less distressing. Baboo Jogendra Nath Ghose had seen abortion occur in fever cases which were being treated with quinine, but whether the accident was due to the disease or the drug he could not say. Baboo Rakhal Das Ghose wished to urge very strongly the importance of rectifying disordered viscera in cases of chronic fever. He had met with a case of 8 months' the administration of 15 grains of pregnancy in which quinine in 3 doses had been followed by abortion. This patient had been previously debilitated by rheumatism. Dr. Cayley had been struck with the power which quinine labour. possesses of accelerated Dr. Branntgan referred to the use of quinine in typhoid fever in which very large doses (as much as 60 grains) were given to reduce the temperature. Dr. Harvey asked whether members had met with many cases of typhoid fever in their practice. He had lately had a most typical one. The testimony of the members who were present was to the effect that cases of typhoid were occasionally met with in Calcutta, but that the disease was not a common one.
CALCUTTA
MEDICAL SOCIETY.
The Fifth Meeting of 1882 was held at the Medical 10th May ; Dr. Harvey presiding. on
College
Wednesday,
Dr. Cayley exhibited two cases in which he had perihe particulars of formed an operation for Trichiasis, the cases and a description of the operation are as follows : CaSe I? J., an European male set. 23, from Dinapur, was admitted into the Eye-Infirmary on 27th April 1882, with of both upper eyelids. On adEntropium and Trichiasis are found incurved in both mission, many of the eye-lashes the eye-ball caused haziness of eyes, and by rubbing against cornea with superficial ulcerations. For the last 6 years he has been suffering from weak eyes, and 3 years ago had a bad attack of purulent ophthalmia, which was followed by growing in of the lashes. An operation for Trichiasis was performed under chloroform on the 28th April 1882. The external commissure Desmain's forceps were applied having been divided by scissors, incision was made along the the upper lid-and an on the ocular side of the bulbs of edge of the lid behind or the lashes and splitting the cartilage to a depth of nearly ith inch. An ovoid flap of skin was then dissected off from the outer surface of the lid of about i inch broad in the centre and of the orbicularis near the edge some of the muscular fibres scissors. The edges of the skin of the lid were shaved off by fine silk suture. In this method wound were then united by the cutaneous edge of the lid containing the lashes,?and the to carry the first incision, which greatest care must be taken the hd, quite behind the roots of ALL of the edge along goes the lashes, or one lash left behind may reproduce all the misfrom the eye, and fixed in its chief?is turned quite away whilst at the same time the connew or natural direction, lid is not injured, and no after junctival surface of the cicatrix or contraction is left theie. In many cases where I have performed the operation the after results have been most perfect, and no outward left. deformity or unsightliness is The In the 2nd case the operation was similar to the first. left eye was operated on on May 3rd. The right eye, which is lemains to be done. very slightly affected, still Both patients were carefully questioned and examined by several members of the Society. The reposition of the lashes The cornea: were clear, and the patients acwas complete. that they had derived great comfort and
under?
knowledged
relief from the operation. Dr. Cayley also exhibited the case of hernia which he had referred to at the previous meeting. This man had suffered from a strangulated hernia of the right side 4 years reduced by operation ; but no attempt ago which had been radical cure ; on this occasion the was made to obtain a on strangulated hernia existed a the left side and the sac and pillars were dealt with with view to a radical cure as stated The wound has now healed ; there is a at the April meeting. of and considepressed cicatrix at the site it. the external ring The scrotum is of natural derable induration beneath cord somewhat thickened, canal adherent to it, and no
size,
impulse
on
to descent.
reducible.
standing
or
coughing, nor any apparent tendency opposite side is scrotal but
The hernia on the .
,
.
,
,
,
Dr. Raye related a very interesting case in which he had been obliged to operate for an irreducible hekjua, and after-
164
THE INDIAN MEDICAL GAZETTE.
wards took the opportunity of performing an operation for the radical cure of the rupture. The particulars of the case are as follows :? Kangali Das, a Hindu male, ajt 40, grocer by occupation, and resident of Sealdah : a healthy robust man, admitted into the 2nd Surgeon's ward, Medical College Hospital, on the lGth April 1882, with a large scrotal liemia of left side and double hydrocele, both of nearly five years' duration. The gut is said to have descended into the scrotum at frequent intervals despite the truss, which was constantly worn : the gut on each occasion used to be pushed back by the patient himself. Condition on admission. ?The tumour was about the size of an adult's head, irregular and somewhat rounded in shape ; testicle could be felt distinctly in the upper and back part of the tumour, which had a soft doughy feeling in front and below with a at the upper part. tense feeling The hernia seemed to be in part omentum and in part bowel. There was also a large hydrocele. Symptoms of strangulation had existed for about twelve hours. The patient was operated on about four hours after admission. The hydrocele was first tapped by a small trochar when about 1? pint of hydrocele fluid escaped ; next the patient was chloroformed ; taxis tried for ^ of an hour, but in vain : an incision about 3 inches long was then made along the axis of the tumour ; skin and superficial fascia divided ; the constriction at the neck of the sac was then divided guided by a director ; next the sac was explored right around and the hernia reduced without opening the sac. Immediately after the gut and omentum had been returned into the .abdomen the sac filled up tensely with peritoneal fluid. The lower part of the sac was then seen to be of old standing, and its upper portion thin transparent unaltered peritoneum, evidently a recent descent. Finding it impossible to keep the sac empty, it was determined to dissect it out, tie its neck and remove it, and thereafter bring the pillars of the ring together with catgut. The original incision was extended down on the scrotum, the sac separated from the surrounding tissues with great difficulty owing to its extreme thinness, keeping the spermatic cord out of the way. A strong catgut ligature was next placed round the neck of the sac, which was nipped off by a pair of scissors ; the stump 'thus formed was allowed to fall back into the ring. As the pillars were about to be brought together a gush of peritoneal flnid escaped from the canal, and on drawing down the stump of the sac it was found that the ligature on it had given way, laying open thus the peritoneal cavity. At this moment the abdomen became suddenly distended with air drawn in no doubt at the instant the ligature on the neck of the sac had given way. A fresh ligature was applied and the operation completed by passing two stout catgut ligatures through the pillars and conjoined tendon. The skin ?wound was closed by metal suture. The patient seemed much relieved after the operation ; had no rigor till the 19th ; the temperature ranging from 99? to 100*. The abdominal wound healed partly by the 1st intention, but the cavity left in the scrotum after the removal of the sac suppurated ; counter openings had to be made at various dates ; and at length the whole scrotum was laid open and made to close by granulation. Beyond these accidents, the progress of the case was uninterruptedly satisfactory, and the patient is now convalescent. It is interesting to note that the freshly descended peritoneum bore with impunity somewhat rough handling, also the manner in which the sac became distended with fluid when its own contents were returned ; how to treat this occurrence was somewhat puzzling ; short of the radical method adopted, tapping the sac might have been employed, but as the peritoneal cavity contained a good deal of fluid this measure would scarcely have been effectual. Can the accidental escape of the peritoneal fluid have been actually advantageous to the patient? The peritoneal cavity, it is to be noted, got distended with air, but no peritonitis resulted. The operation was performed under spray and antiseptically ; Dr. McLeod, who frequently adopts this modified method of the radical cure, being present, and kindly
assisting.
Dr. Harvey remarked that the case just related seemed to fall in with Dr. Marion Sims' views regarding the impunity with which the peritoneum could be handled under certain
[June 1,
188L\
circumstances.
The harmlessness of the entry of atmosair into a healthy peritoneum was also illustrated. Dr. McLeod referred to cases of emphysema and pneumothorax consequent on broken ribs and the absence of any inflammatory or septic mischief in such cases. Since the last had he another case of hernia meeting very interesting which he would relate.
pheric
Kawajut, a Mahomedan aged 45, was admitted into hospital on the 5th of April at 3 P. M., with an irreducible inguinal hernia of the right side. It had been down since 10 A. M.?5 hours. He had only noticed the rupture a fortnight ago. He had also a large hydrocele on the right side and some elephantoid thickening of the scrotum. There were no symptoms of strangulation ; no vomiting or sickness. He had had a motion in the morning. The rupture was reduced the same evening after the application of ice and administration of opium. He was kept under observation till the 9th, when his intestinal functions being normal and general health good, an operation was performed for the cure of the scrotal tumour, hydrocele and hernia. The thickened part of the scrotum was removed ; the skin of the penis which was healthv being left. The hydrocele was then emptied (it contained 8 oz. of fluid) and the tunica cut off close to the testicle. There was a small hydrocele on the left side which was similarly dealt with. The right tunica was extremely thickened and the testicle flattened and wasted. The cord was very voluminous, and its veins varicose. The sac of the hernia was then sought for, found, dissected out, ligatured with three catgut loops atIt the neck, the stump seemed to be an old reduced, and the rest amputated. and adherent to the canal sac, and was somewhat thickened and cord. The pillars and conjoined tendon were then thread which was passed brought together by a double catgut to the spine of the pubis by means of a hernia needle close The cord. thus the outside of loop formed and on the inside on the pubis. The ends was felt to clamp the cord somewhat Pockets were now made in the were left long for drainage. perinseum for the testes which were stitched together in the usual way, the remains of the scrotum being brought over them by a continuous catgut suture. The tumour weighed 13 oz. The operation was performed antiseptically and to the wound in the usual an antiseptic dressing applied took place blood of Considerable oozing during the way. ; temp. 1003. The day necessitating change of dressings Next bladder was relieved by catheter. morning (10th), the He had been very restless, temperature had risen to 101.? On and was still unable to pass water. exposing the cord and right testicle had wound it was found that the lost their vitality. They were therefore freed by cutting and after them, the cord had which secured the stitches been tied by a thick catgut thread, the whole mass was vessels was found amputated ; the blood in the spermatic to have become coagulated. The testis was livid and tore The dressings were reapplied. The asunder with ease. second operation caused some shock, and the temperature Some bronchial irritation was rose to 102'8? in the evening. _
A detected. On the 11th, some cedematous lnnitratioll of the groin and the noticed ; temperature fell upper part of the thigh were to 101?. He was more comfortable next day ; made water. was putrid ; temp. The cedema had spread and the discharge 100?. On the 13th suppuration was detected along the course after castor stool oil; the abscess of the right cord. Had one in the groin became so evident on the 15th that a free counter from 101? to 103.c opening was made ; temperature ranging Has bronchitis. From this time matters went on satisfactorily. The abscess was drained through tubes. A symmetrical abscess was opened on the opposite side. The left testicle adhered kindly to the skin and perinaeal wound had gradually got enveloped in granulations ; the foetor of the discharges abated [and now (27th May) nothing remains but a small ulcer on the right side of the scrotum at the foot of the penis. The sinus resulting from the left abscess closed rapidly, that of the right side more slowly. There is no sign of the return of the hernia, and his general health is good]. This man might be said to have undergone four serious of a scrotal operations in 2 days, namely (1) removal tumour ; (2) laying open of 2 hydroceles and removal of the tunicfe ; f3) amputation of the hernial sac and approximation of the pillars,' and (4) castration. He was somewhat them, but never really in danger. The case convey.
upset by
June 1,
REVIEWS.
1882.]
ed a good practical lesson?not to enter the needle too close to the spine of the pubis. Dr. McLeod had seen gangrene of the cord and testicle result from this cause in 3 other cases.
Dr. Harvey showed a foetus which he had that day removed from a dwarf by Cephalotripsy. The woman was 3 feet 8 inches high. It was her first pregnancy, and she was at about the 7th month of utero-gestation. She belonged to a family of dwarfs. Her father was a dwarf and her sister. The latter had been delivered by forceps at the 7th month by Dr. Charles in the Medical College. She lived for 2 or 3 years after that. This patient had been in labour 80 hours ?when she was admitted. She was in the 2nd stage ; the membranes having ruptured at 9 A. m. that morning. The child had been dead some time. There was a caput succedaneum low down, and the head was jammed at the brim. The external conjugate diameter of Beaudelocq measured 5| inch. Assuming the thickness of the sacrum to be 2J inches and of the symphysis i inch, this left an available conjugate of 2? in. Patient was very low ; pulse 128, respiration hurried ; temperature 100?. The choice lay between the Csesarian section and and looking to the low state of the patient and the fact that the child was dead, the latter was selected.
cephalotripsy,
The head was broken up an(l crushed, the eyes being squeezed out. The thorax was opened in two places, and after
delivery of the arms extraction was accomplished. The placenta came away an hour after. Patient was very low, and no hopes of her recovery were entertained. Baboo Rakhal Das GHOSE had seen a case of cephalotripsy performed by Dr. Charles in 1873. The woman died. The adjourned discussion on the use and abuse op Quinine in pevep- was opened by Dr. Harvey, who remarked that his own experience did not cause him to dread the ecbolic action which quinine was reputed to possess. Dr. Albert Smith of Philadelphia had propounded the doctrine that quinine had no power of originating uterine contraction, but that it had the power of increasing them when
'
otherwise aroused. He was inclined to accept this doctrine. He could cite the case of a lady seven months' pregnant who had taken 30 grains of quinine in one day for hemicrania. The drug had no effect on the uterus. The same patient took 3 10-grain doses of quinine in one day four days ago, without any harm resulting. In another case he endeavoured to cause premature labour by giving 30 grains of quinine daily for 4 days. Nothing occurred. The patient was then fed on raw pineapples, which were reputed abortifacients, for four days without result. Finally labour was brought on in the usual way. At the same time he was in the habit of giving quinine cautiously to pregnant women. He had known uterine pains induced by quinine, but never abortion. He had found that when given in pill, quinine was not so apt to produce uncomfortable effects. The pills must however be freshly made. Baboo Lall Madhub Mookerjee was in the habit of giving quinine to pregnant women, when it was otherwise indicated, to the extent of twenty grains a day without any bad consequence. There was among natives a prejudice against giving medicine of any kind, to females when they were in the family way. Mr. Wallace referred to the observations of Dr. Simmonds of Japan, published in an American paper, which went to show that quinine was specially dangerous from the 3rd to the 5th mouth, and when the system was lowered from other causes. Moulvie Zuheroodeen Ahmed had served in Burdwan during the epidemic of 1871-2-3. There was an attendance at his dispensary of some three or four hundred patients a day. The daily consumption of quinine was about 1 lb. Amongst the patients hundreds of pregnant women came, and he does not remember one single instance in which abortion was caused by the administration of quinine. He did not agree with Baboo Rakhal Das Ghose about the uselessness of quinine in chronic malarial fevers. He had used it largely in such cases?giving it in 2 grain doses twice or thrice a day. It certainly seemed to reduce the size of the liver and and remove, the fever.
spleen
Dr. McLeod had found the addition of hydrobromic acid to quinine obviate the uncomfortable effects on stomach and head which the drug sometimes caused.
165
Dr. Raye had observed that the same combination rendered the phenomenon of tinnitus aurium less distressing. Baboo Jogendra Nath Ghose had seen abortion occur in fever cases which were being treated with quinine, but whether the accident was due to the disease or the drug he could not say. Baboo Rakhal Das Ghose wished to urge very strongly the importance of rectifying disordered viscera in cases of chronic fever. He had met with a case of 8 months' the administration of 15 grains of pregnancy in which quinine in 3 doses had been followed by abortion. This patient had been previously debilitated by rheumatism. Dr. Cayley had been struck with the power which quinine labour. possesses of accelerated Dr. Branntgan referred to the use of quinine in typhoid fever in which very large doses (as much as 60 grains) were given to reduce the temperature. Dr. Harvey asked whether members had met with many cases of typhoid fever in their practice. He had lately had a most typical one. The testimony of the members who were present was to the effect that cases of typhoid were occasionally met with in Calcutta, but that the disease was not a common one.
