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Entrance of Air into the Uterine VeinsAuthor(s): Albert OwenSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 14, No. 25 (Dec. 11, 1850), pp.698-699Published by: BMJStable URL: http://www.jstor.org/stable/25492784 .

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698 CORRESPONDENCE.?ENTRANCE OF AIR INTO THE UTERINE VEINS.

seldom continued longer than a week. Sometimes the

stools are somewhat increased in quantity, but neither

vomiting nor any other ill effect is produced. The only

precaution the while is the abstinence from alcoholic

drinks and too stimulating a diet.?V Union M?dicale.

MIDWIFERY AND DISEASES OF WOMEN.

On Displacement of the Ovary.?By Dr. Rigby.

Dr. Rigby states that for the last three years he has

noticed several instances of a painful affection of the

pelvis, which appeared to him to be new. It was

characterised by intense sickening pain about the

sacral region, extending to one or other of the groins, and coming on in most agonizing paroxysms. Some

times there were complete intermissions, in others the

pain never entirely subsided. The patient describes

the sensation of some obstruction in the rectum, the

passage of faeces giving rise to the pain, which is of a

peculiarly intolerable character, and, according to the

author, appears to resemble that of orchitis. There is

usually also much throbbing, with a sense of forcing. The menstrual periods in all the cases noticed have

been attended with much increase of pain, and the

discharge was always attended with coagula. The

lower part of the abdomen at these times was extremely

tender, and more or less fever was present. The tongue was always furred, and the digestion was materially

deranged. On making a vaginal examination the patient would

frequently wince, and complain as soon as the finger touched the os and cervix uteri, but a little care quickly sufficed to show that these parts were not morbidly

tender, but that pain was produced by pressing them

against the tender spot which was behind and to one

side, in the direction of one or other of the sacro-iliac

synchondroses, or sacro-ischiatic notches. On passing the finger, therefore, behind and to one side of the

cervix, and pressing against the wall of the vagina in

the above-mentioned direction, the painful spot is at

once reached, and sometimes a slight degree of hardness

is perceived. On examining per rectum, the finger soon reaches

the same acutely painful spot, which had been felt per

vaginam. The patient dreads the slightest touch of it,

however carefully applied. It is evidently a convex

body, like an enlarged gland, though usually softer,

situated in the recto-vaginal pouch ; it is moveable, if

the patient can bear a sufficient amount of pressure for

that purpose, and usually one or more vessels are f It

throbbing when the finger presses upon it. The ovary

is generally larger than natural, being more or less

swollen from the strangulation produced by its displace ment ; and when the swelling is considerable, not only will pain be produced by pressing in the groin of the

same side, but the ovary will be distinctly moved upon

the finger per rectum. From the fact of its mobility can be explained the circumstance of our being able to

feel it sometimes lower in the pelvis than at others,

and why the patient is in greater suffering when it is so

than when felt higher up. Hence the passage of a

solid mass of feculent matter is attended with fearful

sufferings; the ovary is pushed down by the faecal mass as it descends through the rectum, until its attach

ments are put considerably on the stretch; a further amount of swelling is produced by this state of strangu lation, and in this condition the faecal mass is at length forced past, to the indescribable agony of the patient,

frequently leaving her in severe pain for many hours afterwards.

In other cases the ovary is nearly or quite fixed;

having appafently contracted adhesions to the neigh

bouring parts. Dr. Rigby does not speak decidedly as to the causes

of this displacement, but he chiefly, or almost solely, observed it among women of a lax, flabby habit, prone to passive menorrhagia, leucorrh a, and abortion, but

most particularly where the uterus has been retroverted.

The diagnosis is not difficult, for the pain is quite

peculiar. It is of a forcing, throbbing character, so

sickening and utterly intolerable as to be entirely different from any other pelvic pain. Its seat is re

ferred to the upper and posterior part of the vagina,

usually somewhat to the left side where the ovary can

be felt, especially upon examination per rectum.

The direction in which we can best reach the painful

spot will guide us to applying leeches per rectum or

vagina ; they pretty certainly produce much relief,

although, so long as the displacement continues, it

cannot be more than temporary. The grand object must be to restore the ovary to its natural position, and this, whether connected or not with r?troversion, will be best obtained by the prone position. The

patient soon learns by experience what amount of

lying forwards will be required, but, as in cases of

r?troversion, it is generally found necessary to assume

an extra degree of prone position for a few minutes

(knees and elbows) previous to lying down prone upon

I the couch.?Medical Times, July 6, 1850.

ENTRANCE OF AIR INTO THE UTERINE

| VEINS.

To the Editors of the Provincial Medical and Surgical Journal.

Gentlemen,?As regards the subject of the " En

trance of Air into the Uterine Sinuses and thence pro

ducing fatal effects by its presence in the Heart," I

think there can be no doubt that, as your correspendent observes, the preventive treatment should be to endea

vour to obtain *' natural and permanent contraction"

of the uterus after delivery ; and having had a very fair

share of midwifery practice since I first entered that

branch of our profession, twenty years ago, under Dr.

Waller, (some of whose little hints, given to me at that

time, have often been of most inestimable value since,) I

venture to sugest what has hitherto proved to me an

I unerring safeguard against many of such untoward

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CORRESPONDENCE.?HOM OPATHIC FRAUDS. 699

?vents, as floodings after delivery, or the entrance of

air into the sinuses, &c, and which plan, from its sim

plicity, I have often been surprised to find should not

be more generally adopted by practitioners. I mean

the application of a towel or some sort of wide bandage

tightly round the abdomen so soon as the os uteri

becomes moderately dilated, which not only is declared

by the patient to give much delightful "

support," but

by concentrating as it were, (if I may use the expression,) the pains upon the contents of the uterus, appears to

me to cause much greater effect to be produced, and as j

the bandage is tightened in proportion to the progress of the labour, so is there a decided impediment to a

flabby state of the uterus occurring; and when the

placenta is discharged, the additional application of

two or three napkins in the form of a pad or compress over the uterus, in a manner, seems mechanically to

prevent anything like an expansion of that viscus, and

consequently there is no chance of the mouths of the

vessels receiving air or discharging blood.

Should you deem these observations worthy of a

place in the Journal, they are quite at your service.

I am, Sir, your obedient Servant, ALBERT OWEN.

Aylesbury, December 2, 1850.

ON ALLOPATHIC DOSES IN HOM OPATHY.

To the Editor of the Provincial Medical and Surgical Journal.

Sir,?In answer to a letter from a correspondent, in

last week's Journal, I beg to suggest the following extract from Mr. Taylor's valuable work on poisons :

" lam not aware that the salts of morphia have been

commonly used as poisons in this country, but it is

necessary to state that they are sometimes recklessly prescribed in dangerous doses. The following case, referred to me in July, 1847, is instructive in more

than one point of view :?A lady of this metropolis consulted a homoeopathic physician, who had acquired .great repute as an advocate of the system of infinitesimal doses. He prepared and gave to her some small white

powders, with explicit instructions in writing as to the mode of taking them, and the nights on which they were to be taken. She took, as I was informed, two, and on each occasion she suffered from great stupor, and all the symptoms of narcotic poisoning, followed

by diarrhoea. A suspicion arose that the powders con

tained some very active ingredient, and three of them were sent to me for analysis. It was first ascertained

that, although in appearance and from the directions

they were intended to pass as equally divided doses of

the same medicine, they differed greatly in weight. The first weighed 3.4 grains : it consisted of calomel

and morphia ; the latter being in the proportion of one

grain! The second weighed 1.5 grains: it consisted

entirely of sugar of milk, (or some amount of anala

gous sugar,) and contained no morphia, nor any mineral

matter. The third weighed 2 grains : it was composed of calomel and morphia ; the latter forming about one

fourth the weight, or half a grain. The cause of the

alarming symptoms was at once explained. It will be

perceived from the analysis that the powders differed

from each other in weight by more than one half, and

that the first contained a dose of morphia which might have proved fatal, had it been taken according to the written order ; while the second was an innocent pow der, of which a person might have swallowed an ounce

with impunity, and yet it was less than half the weight of the really poisonous powder. The third contained a full dose of morphia. The quantity of morphia which the patient took cannot be conjectured, as the

doses of morphia in the remaining powder followed no

regular rule ; but it appears to have been sufficient to

destroy her confidence for ever in infinitesimal doses. This case, while it shows, in an unsuspected way, the

gross deception practised on the public, and the risk of

life which must be incurrred by such a reckless mode i of prescribing, affords a hint of some value to the medical jurist. Let us imagine that the patient had taken the powder containing the grain of morphia and

had died from its effects, and that only the second of

the powders, with the written directions, had been

forwarded to the chemist for analysis. This would

have been found to be sugar of milk, a substance which

could have been productive of no mischief. Had a

charge of manslaughter even arisen, there would have

been an admirable ground of defence in the allegation that the unfortunate deceased had died of apoplexy; for it would have been argued,?she could have taken

nothing but sugar of milk, with perhaps a harmless

decillionth dose of some homoeopathic medicine ! The

prescriber, under these circumstances, would probably have been triumphantly acquitted."

I am, Sir, your obedient Servant, R. ARNOLD.

Surgeons' Dresser, Suffolk General Hospital.

Bury St. Edmunds, Nov. 19 1850.

IMPERMEABLE PILINE.

To the Editor of the Provincial Medical and Surgical Journal.

Sir,?Allow me to correct an error which occurs in this week's number, in a quotation from a letter of mine in the Medical Times of November 2nd. By referring to that journal you will find that I have recommended the "

Impermeable Piline" as a means of producing diaphoresis, and not the "

Spongio Piline,ft as stated by you. I may, however mention, en passant, that this material, used in a similar way, for applying hot water to the entire surface of the

body, will be found very useful in cases where the

general effect of heat and moisture is required. I am, Sir, yours obediently,

ALFRED MARKWICK.

19,Langham Place, Nov. 28, 1850.

M?lul SnMltgnirt THE COFFIN DRUGS.

An inquest has been recently held at Haggerstone, before Mr. Baker, the Coroner, on the body of Mr. Bedwell. The jury found a verdict, "That the

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