stated that in one of the uses to which it may be put, it is inefficient; in the other, either equally powerless or highly injurious. As a tractor, the finger of the opposing hand forming the second blade of a forceps, it is powerless; as a lever, with the hand of the operator for a fulcrum, it is equally powerless; and if the pubis, the os ischii, or the soft parts, be suffered to form the point d'appui, the woman must afterward inevitably suffer from inflammation and its accompanying ills. How is it, then, that in older writers we find the instrument so highly commended? Dewees in particular praises it, lauds its benefits, and sneers at its opposers. We are inclined to think that either the benefits derived were not so great as supposed, or that the after results were disregarded. The great difficulty in using the lever is the want of a fulcrum. It was that only that Archimedes is reported to have needed to move the world. Now, as no part of the mother should for a moment be thought of for a fulcrum, and as the left hand of the operator, applied near the neck of the instrument-on account of its want of stability, and the awkwardness, if not impossibility of thus manipulating-as a fulcrum is inefficient, we must seek for some other fulcrum. It has occurred to me, that by lengthening the handle of the lever, we may make the extremity of the handle rest upon the elbow of the operator-the hand grasping the center of the instrument-and from the elbow obtaining the purchase, constituting it, in philosophical terms, a lever of the third kind. In this manner no possible injury could happen to the mother; the force being applied at the center of the instrument, counteracted by the elbow (the fulcrum), and exerted solely upon the presenting portion of the child. In accordance with this idea, an instrument is in process of manufacture for me, by Mons. Luer, now in Paris. Both ends are to be terminated with a fenestra, which, while in reality being a double instrument with different curvatures, will by receiving the olecranon steady the instrument on its application. For convenience in carrying, the instrument will close with a hinge, fastened when in use by a sliding bolt. With this lever I anticipate in some few cases, that the position of the head may be changed; in face presentations, by its use the occiput may be substituted for the face, &c. Ir presentations of the breech, as a tractor, some service may be rendered where the delivery is delayed from want of power, or by any impediment, and to assist in the subse quent delivery of the head, frequently so difficult and fatal to the child. I do not presume that by this or any modification, the lever can ever successfully compete with the forceps; but in some cases it may perhaps be substituted for a more formidable-looking instrument, requiring double the trouble in its application, and more frequently the exposure of the patient. It will appear obvious, that when the instrument is to be applied under the pubis, little is gained by this modification, unless the patient be turned very much to one side; but I do not pretend to make it a perfect instrument. In the great majority of cases, it is but a half instrument; still, even in these cases the instrument is not inferior to the ordinary form, which is found in every obstetric case. So long as it is deemed worthy of this place, it is worth our while to render it as efficient as possible. New York, 141 East Thirteenth, August, 1854. Case of Death by Chloroform. By G. HUFF, M. D., Lexington, Ky. A married lady, 33 years of age, very tall, with auburn hair, and of a nervous temperament, with very large anterior cranial developement, and a powerful intellect (she had studied law, medicine, and divinity), who was suffering with neuralgic pains in the lumbar region a short time since, desired me to administer chloroform to her, in order to mitigate the pain. I positively refused to do so, and informed her that her nervous system was too weak to take it with safety. The following day she was said to have suffered more, and, as I was informed, most excruciatingly; and her friends administered chloroform at intervals for twelve hours before I saw her again. When next seen, she appeared as if just aroused from a chloroform stupor; she had a very fine pulse, indeed I could scarcely detect any. I inquired if she had not inhaled chloroform; and the reply was in the affirmative. I informed her friends that she must have no more. She, in a very imploring manner desired me to let her have some. I never saw a bacchanalian more solicitous for his cups, than this lady was for chloroform. At this juncture, I applied galvanism in order to excite circulation; and in fact I was obliged to increase the current to a very high tension before I could excite sensation. After it was partially restored, I discontinued its use, and she slept one hour, as I supposed, naturally. She then aroused, and again plead for chloroform. Her pulse continued the same (very fine): after a short time she was taken with coma, which continued for two hours; at the end of which time she aroused, apparently in great distress, and continued in that condition two hours. The power of voluntary motion and sensation appeared now to be gone; but the pulmonary branches of the par vagum continued to excite, through the medulla oblongata, the involuntary movements of the thorax; and as the cranio-spinal axis became involved, and reflex power ceased, breathing ceased, and, of course, life became extinct, at the end of twelve hours from the time I found her under the influence of chloroform, and twenty-four hours from the time it was first administered. I am of opinion that if the application of electricity had been persevered in, she would have recovered from the effects of chloroform. Proceedings of Societies. NEW-YORK ACADEMY OF MEDICINE. Summary of its Proceedings. STATED meeting at the University, Sept. 6th, 1854. President, Jos. M. SMITH, in the chair. Thirty-six Fellows were in attendance. After the reading and approval of the minutes of the last meeting, the President called for the reports of the various committees, this being one of the three business meetings during the year. Reports were received from the Committees on Ethics, and on Finance, together with the Board of Trustees. The recommendation of the Trustees in relation to the tax upon absent Fellows, viz., that those who had permanently removed should not be liable, while those who were temporarily absent should be considered as on the register, was adopted. The Treasurer reported a balance of $182 19 in the treasury. This is independent of money invested in bonds and mortgages. The discussion on Cholera was then resumed. Dr. Batchelder presented his views, at some length, as to the nature and treatment of cholera. Considers it " an effusion of serum into the cavity of the stomach and bowels, produced by the constriction of the external capillaries, thereby throwing the fluids upon the internal surface of these organs. A similar cause exists in intermittent fever; but there is no internal effusion, the vessels of the surface at first resist, and afterwards relax, the paroxysm terminating in perspiration. On the surface of the body is spread out a thin cuticle, which permits exudation of perspirable matter, but preventing the escape of serum; it also pre vents the absorption of deleterious agents. If the cuticle becomes detached, serum is effused, as under the effects of a blister, or where bullæ are developed, &c. In the intestines during an attack of cholera, the epithelium is detached, and there being nothing to resist the discharge, the serum of the blood is abundantly poured out: the patient may be said to bleed to death. The indication of treatment in this state of things is to constringe these vessels thus pouring out serum: this is best accomplished by acetate of lead and opium, which in its use, is sanctioned by analogy, being used with advantage in all internal hemorrhages; it should be administered after each dejection. Tannin or bismuth may be substituted where the former remedy is not tolerated. Endeavor to prevent the determination to the internal surfaces: when all remedies are ejected, use external medication. Ligatures around the limbs, by retaining the blood in those parts, are useful; they should be occasionally loosened, so as to allow a free supply of blood to the organs. Large cups will draw the fluids to the surface, and prove beneficial in this way. Blisters, mustard, and external heat may be used, the latter, indiscriminately, but the temperature should be gradually increased. The stage of reaction follows, and often destroys the patient: 1st, in consequence of the fluids being drawn to the surface, there is not enough vitality to carry on internal life; 2d. by effusion taking place upon the brain and spinal marrow. Dr. R. S. Kissam was very much interested in the remarks of Dr. Batchelder, especially that part which refers to the appearance of the epithelium in the evacuations. Sometimes, however, it does not occur, as in those very rapid cases, which run their course in a few hours. Cholera does not always consist in large evacuations, but frequently results from the impression which is produced on the nervous system by the morbific agent. In the case of a lady whom he attended, there was a copious secretion from the skin, accompanied by a comatose condition, and which actually required purgatives for relief. Dr. Batchelder remarked, that where there was no vomiting or purging; the intestines, after death, were found filled with fluid, and this was loaded with epithelium. Dr. Detmold thought that too much importance had been attached to the appearance of epithelium in the discharges. It may be seen in all discharges where there has been congestion of the vessels; and in proportion to the amount of congestion and the quantity of the discharge will be the amount of epithelium. It is found in discharges from the nose, vagina, and in disease of the kidney. He therefore considers its appearance of secondary importance. As to the treatment, the proportion of deaths to the number of cases treated has been the same under different plans of treatment. The dry cupping has been tried without any benefit. Dr. D. thinks there is more speculation than truth in Dr. B.'s theory. Dr. J. G. Adams presented a work "on Syphilization," from Dr. Sperino, of Turin, Italy, with a request from the author that it might be referred to a commission, as this new doctrine had excited much discus sion in the learned societies of Europe, and Dr. Sperino considered that it had not met with that unprejudiced examination which it merited. It was referred to the Committee on Surgery. On motion of Dr. Cock, it was resolved, "That a vote of thanks be presented to Dr. Sperino for his donation; and that the Foreign Corresponding Secretary be directed to communicate it to the author." The Committee on Theory and Practice recommended the subject of Dysentery for discussion at the next meeting of the Academy, which was on motion adopted. Dr. Adams announced to the Academy, the death of Dr. Samuel W. Moore, which occurred on the 26th August, and presented the following resolutions, viz.: Resolved. That this Academy has learned with profound regret, of the decease of Dr. S. W. Moore, late Fellow of this Academy. Resolved. That in the decease of Dr. Moore, the medical profession has lost a high-minded and honorable practitioner, who, during a long and successful career of practice, sustained the dignity of the profession, while by his devotion to its interests, his kind feelings towards his professional brethren, no less than by the purity of his life, he has left an example worthy of all imitation. Resolved. That the Recording Secretary be instructed to convey to the afflicted family of the deceased our sincere condolence on this mournful event; and that these resolutions be recorded upon the minutes. The President appointed Dr. Wilkes to write a biography of Dr. S. W. Moore. had The Secretary announced that the Assistant Secretary, Dr. Stimson to Europe, on account of his health; whereupon Dr. John W. Green was appointed to fill the vacancy of Dr. Stimson, during his ab sence. gone The President announced that he had appointed Dr. D. M. Reese as biographer of Dr. Isaac Greene, and Dr. W. W. Jones, as biographer of Dr. W. H. Macneven. Mr. Holmes, of South Carolina, exhibited to the Academy a chair adapted to invalids; its construction and its adaptation to the wants of those for whom it was constructed, were fully explained by Dr. Sims. Adjourned. II.-NEW YORK PATHOLOGICAL SOCIETY. Extracts from the Minutes, by J. FOSTER JENKINS, M. D. Secretary. March 22nd. Dr. Finnell exhibited a schirrous mamma, removed from a married woman, æt. 40 years. |