253

OSPEDALE SANTA MARIA NUOVA,AT FLORENCE.

CASE IN WHICH THE CÆSARIAN OPERATION

WAS SUCCESSFULLY PERFORMED.

E. ZENOBINI, ætat. 23, of a feeble consti-

tution, and who, in her childhood, had suffer-ed much from rachitis, felt, on the 11 th of

May, the first symptoms of approachinbparturition. The pains, within a short

time, increased to an extraordinary degree ;and, after twenty-four hours, the membranesburst, but without being followed by theexpulsion of the child. After the patienthad remained in this condition for two days,the midwife, who attended her, sent forDr. Lotti, who, after an accurate examina-tion, declared that the malformation of thepelvis prevented delivery in the ordinaryway; the umbilical cord, which had de-scended, being without any pulsation, heinferred that the child was dead, and in-sisted upon the patient’s being immediatelyremoved to the hospital, in order to haverecourse to surgical aid, without any fur-ther delay. In the hospital, she was againexamined ; and it having been found thatthe largest diameter, from the pubes to thesacrum, was not more than three fingers ;the professors of the surgical department,and of the internal clinic, were sent for toconsult on the best means of delivering thepatient. The Cæsarian operation beingunanimously resolved upon, M. Tassinari,one of the oldest and most experienced pu-pils of the Institution,* was chosen to per-form it in the presence, and under the

superintendence of the Professsors, MM.Ucdli, Bigeschi, Betti, Andreini, and Mi-clielacci. The patient having been placedon a table, M. Tassinari raised a trans-

verse fold of the integuments, between theumbilicus and the pubes, and divided it over,and parallel with, the median line ; a

director was now carried under the aponeu-rosis of the abdominal muscles, and the

* It is the praiseworthy custom of ourhospital, that all operations, are performedby the first pupil of the surgical depart-ment, provided that after several examina-tions, and after having performed every sur-gical operation several times on the deadsubject, he has shown himself fully capableof it. Of course the young operator actsuuder our immediate direction and supelin-tendence, so that, at the least accident, theoperation may be terminated by the pro-fessoi ; in fact, he and the operating pupilmay be considered as one and the same per-son. The immense advantages of’ this prac-tice are apparent; the attention of the

latter divided upon it ; the peritoneumhaving thus been laid bare, it was lifted upbv a small pair of forceps, and divided bythe scissars, The uterus now presenteditself in a contracted state, and BBas openedlongitudinally by a probe-pointed bistouri ;M. Vlichellacci seized the child’s feet ; andwhile Professor Ucelli, with his hand in-troduced into the vagina, raised its head,succeeded in extracting it with the greatestfacility. The umbilical cord was divided,and the placenta removed through the

vagina. The child was without any signs oflife. The edges of the wound were nowbrought together, and kept in this situationby five sutures ; a tent was placed in thelower angle, in order to promote the evacua-tion of purulent matter; the wound wascovered with lint, and a uniting bandage.After the operation, the patient was allowednothing but fluids. During the followingnight she had a violent attack of fever, witha sharp resistant pulse, to which tympanitis,vomiting, and ischuria, soon succeeded;the abdomen was verv tender, and someblood escaped from the wound and the

vagina. By repeated bleeding, the use ofice-water, and emollient clysters, these

symptoms were happily subdued ; and, onthe 17th, the lochial flux began to appear.From the 20th, much purulent matter es-caped from the wound and vagina, and thebreasts swelled and became painful. Onthe 21st, the bandage was, for the first time,removed ; the wound had completely unitedexcept at its lower angle, from which thetent was now removed. During the fol-

lowing days, the fever abated; the alvineexcretions became regular, the patient re-covered her appetite, notwithstanding whichthe low diet was continued. On the 27th,the sutures were withdrawn, erysipelatousinflammation began to appear near the pubes,but soon disappeared again. The cicatrixbecame more consolidated ; on the 8th ofJune, the patient, was able to leave her bed ;and, on the lbth, she was discharged per-fectly cured.-Repertoire général d’Anato-mie, &c.

pupil is much more attracted and fixed ; heis obliged not only to insttuct, but practi-cally to exercise himself; he thus best ac-

quires that intrepidity, without which nosurgeon ought to enter into his practicalcareer. If there is any one who loses bythis custom of our hospital, it is the pro-fessor who renounces the honour, and takes

upon himself the responsibility of the opera-tion ; but we are justified in assertiug, thatto it chiefly we owe a great’numb.’r of ex-cellent practitioners, and most skilful opera-tors.—Anno di Cliizica eiterua dell’ T. e R.arcispedale di Santa Maria Nuoca, det ProfessoreFilippo Ucelli.

254

THE BATH UNITED HOSPITAL.

n T,tG. - What’s to do ?" BRU. A piece of work that will make sick men

whole."—JUL. CÆS. Act. II. Sc. I.

To the Editor of THE LANCET.

SiR,-I take up my pen to address youwith considerable hesitation and reluctance,the subject being one that I would willinglyresign into other and more able hands. Itis, however, a subject, which, on the highground of justice and humanity, demandsexposition and redress. I allude to thetreatment of out-patients at the BathUnited Hospital. Scarcely a week passeswitheut some application being made formy professional assistance to individuals,who have endeavoured, but in vain, to ob-tain, at the institution alluded to, that relieffrom, or mitigation of their ailments, whichthey had a right to anticipate. It wouldseem, that unless a case is important, i. e., ofrare occurrence, the patient is generally con-signed to the care of an inexperienced youth,under whose judicious management diseasecommonly proves intractable ; and the pa-tient, wearied with fruitless journeys, oftenfrom a considerable distance, has recourse,at length, to private professional aid ; thedistressed applicants usually concludingtheir appeal, with declaring that " theywould rather sell their beds from under them,than again apply at the hospital." Surely thisis a state of things that ought not to besuffered to exist. That it does exist, I assertfrom my own experience, and will illustratemy assertion by a few cases hastily selectedfrom many of a similar character. I was

lately called to visit a female, in the last

stage of carcinomatous disease of the uterus ;she was, in fact, so much reduced, as to ex-pire a few days after my visit. This womanhad attended regularly at the hospital fromthe commencement of her complaint, yethad never been subjected to an examination—never bled, cupped, or leeched, and was, ulti-mately, dismissed with the assurance " thatshe would get beiter as she advanced in life."Dissection demonstrated the fitness of this

subject for Oscander’s operation ; the uterus,although greatly enlarged, being perfectlyfree from unnatural adhesion to the sur-

f

rounding parts-not to speak of the possi-bility of effecting a cure in the eaily stage ofthe disease, by prompt and suitable treat-ment, the greater number of cases termedcancerous, not being strictly so at the com-mencement of diseased action.

I have also been required to take chargeof a case of fi actured clavicle, unreduced forfire days, treated as a bruise, and well rubbedwith a stimulating liniment! by direction of" the young gentleman" in attendance at the

Bath Hospital. And no later than yester-day, a man presented himself before me, hismind in a state of deep depression, his bodycovered with blotches, and suffering fromnocturnal pains in his bones—the result of aprotracted course nf mercury, administered bv" one of the young gentlemen" for blenarrhrra!These are but a few of the cases that couldbe mentioned. That such cases are not

confined to my experience, but that other

practitioners in this city have their share ofthe fruits of hospital mal-practice and neg-lect, may be safely inferred from the fact,that a dispeaasary is on the eve of beingestablished within a short distance of the

hospital, as a matter of speculation, ground.ed on these very circumstances., With regard to the treatment of patientsin the house, if the following case, which isbruited about in this and the neighbouringcity, (Bristol,) be substantially correct, thatclass have as little reason to congratulatethemselves on their situation, as the out-patients. It is confidently affirmed, that ayoung person in the hospital was latelyoperated on for stone, and died. A post.mortem examination demonstrated the utter

impossibility of a stone being extracted bythe operation performed; admittinb it to have been,what I am informed it WAS NOT, a stone case,for the bladder had not been opened in the opera.tion!! the instrument having passed onone side of that viscus. This being the secondknown case, of a similarly unfortunate kind,that has occurred in the practice of thesame operator, it has excited a powerfulsensation, and has called forth some severeremarks (from a correspondent) in the BathJournal of the 19th inst., which hithertohave been suffered to remam unanswered.

It is singular enough, and syciently un-fortunate, that some non-professional-half-learned smatterer, took occasion, a shorttime since, on the strength of hearing a fewlectures delivered over the bodyofGllham the

murderer, to write an article in your Journal,avowedly for the purpose of extolling theBath Hospital surgeons, and doubtless con-ceived he rendered them additional honour,by celebrating their names in connexion

with what he was pleased to consider—their, peculiar and specific virtues,* much after the’ fashion of Scott, when alluding to certainplaces in Liddesdale :

" Bilhope braes for bucks and raes,And carit haugh for swine,

Aud’I’arrasfor the good bull-trout,If he be taen in time."

; * Of the surgeons, Mr. Soden is cele-r brated as an ophthalmic surgeon—Mr. Wil-1 ’son Brown operates successfully in herma—f and Mr. Norman in lithotomy!"—LANCET, Vol. II. No. 2.)1. pp. 368.