Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West.

  • West, Charles, 1816-1898.
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West. Source: Wellcome Collection.

    26/50 (page 24)
    and penetrate their substance. The veins, however, though closely collected around these growths, and presenting a considerable increase of size, do not penetrate their substance, and do not extend beyond their pedicle. The fibro- cellular variety, however, presents a very different arrangement; the cells ob¬ served in the interior of these polypi being, in Dr. Oldham’s opinion, trun¬ cated and divided veins, which traverse the whole tumour, freely communi¬ cating with each other, and forming a very extensive venous circulation. [It is by no means certain, however, that these canals are venous ; the contrary opinion entertained by Meissner, (see his Frauenkrankheiten, Bd. i. p. 833,) is much more probable, and the rather since these canals terminate by open extremities, an arrangement which, notwithstanding Dr. Oldham’s revival of the old theory that the uterine veins terminate in a similar manner, is quite contrary to all that we at present know of the structure of the vascular sys¬ tem.] A case of spontaneous strangulation of a polypus by the os uteri, and its consequent detachment, is related by Dr. Garden.* * * § M. Mayorf has twice successfully employed torsion, as recommended by M. Amussat, for the removal of two large uterine polypi; and in neither case did any ill result follow the proceeding. Various modification in the operation of tying polypi are sug¬ gested by MM. L. Boyer, Quackenbush, Bedingfield, and v. Watmann,J having for their object the easier and more certain application of the ligature. JV1. Boyer’s instrument is rather complicated ; the others are very simple, even more so than Gooch’s canula ; but a description of them would scarcely be in¬ telligible unless accompanied with a drawing. M. Mollet§ relates the history of a woman who had suffered from symptoms of uterine disease for a year, when a tumour appeared beyond the vulva, and increased rapidly in size. It was supposed to be the inverted uterus, and under this supposition a ligature was applied on the fifth day, around the neck of the tumour, and it was then removed by the knife. It was now found that the extirpated uterus had not been inverted at all, but merely drawn down by an immense polypus attached to the os tincse. The patient died on the fifth day after the operation. Fibrous tumours. Dr. Roberts,|| in some remarks on these growths, con¬ firms Dr. Ingleby’s remarks with reference to the frequency of hysteralgia as a consequence of their presence. He notices that they have a peculiar predi¬ lection for the posterior wall of the uterus, and that though they may disappear under the use of medicine, they have a great tendency to return. He confirms Dr. Asliwell’s observations with reference to the utility of iodine in their treat¬ ment. Dr. Pancoast and M. L. Boyer®f[ have each removed a large fibrous tu¬ mour from the uterine cavity; in the former case the operation was attended with success, in the latter the patient died on the sixth day. In both instances the tumour was enucleated partly by the finger, partly by the help of instru¬ ments. In M. Boyer’s case the tumour had not passed the os uteri, which it was necessary to incise, while in Dr. Pancoast’s patient the tumour had passed out of the uterus, and nearly filled the vagina. The different result of the two operations seems to have been greatly dependent on the different relations of the tumours to the os uteri. Malignant diseases of the uterus. Dr. Barbieri**^ relates a case in which an ill-constructed ring-pessary having been retained for several months, became imbedded in an ulceration of the cervix uteri, and gave rise to symptoms which were supposed to be those of ulcerated carcinoma. The presence of the pes¬ sary was not at first detected, but on the removal of the instrument the patient * American Journal of Med. Science, April 1844. 1 Gaz. Med, Aug. 17. 1844. % Bulletin del’Acad.. de Med., Fev. 29, 1844; New York Journal, Jan. 1844; Lancet, May 11, 1844; Oesterr. Med. Jahrb., Jan. Feb. 1845.. § Annales de Therap., Janvier 1845. || New York Journal, Sept..l844. ^ Boston Med. Surg. Journal, Oct. 9, 1844 ; Revue Medicale, Mars 1845. Gaz. Med* di Milano, 29 Giug.no, 1844-