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“It is, unfortunately, not rare to meet with a great number of women, in whom cancer has become incurable, without even its existence having been suspected. Is it a fact, that it is sometimes entirely latent? The mere idea of the affirmative of this, would carry consternation into every family. But fortunately it is not the case. I am convinced, that among the thousands (the author constantly uses this numeral when alluding to his cases) of cases which I have observed I have never yet seen one in which a morbid affection of the uterus, of whatever description it may be, did not manifest itself by easily appreciated symptoms. Thus, leucorrhoea, more or less permanent, anomalies in the menstrual function, lumbar, and other pains, &c. suffice to excite the attention of the well-informed practitioner. He does not forget that the slightest inconveniences originating in, or appearing to do so, affections of the genital organs imperiously require that manual examination, and that by the speculum, should at once be put into force. Since these wise precepts, so much insisted upon by Leuret, have been revived, since women, of all classes of society, have received salutary warnings from others, who themselves have benefited by a timely foresight, we have seen many fewer cases of incurable diseases of the uterus. Some time since, eight or ten women would come every week to La Pitié, in whom cancer of the uterus had proceeded beyond the resources of art, scarcely any of these unfortunate beings having been submitted to examination. At present we scarcely meet with two or three in a month. Let us hope that their number will continue to decrease; and we shall feel too happy if we have been able to contribute to its doing so." 613.
The author frequently alludes to the peculiar odour of cancer, and, in some doubtful cases, considers it may aid the diagnosis.
"The retention of coagula and secretions in the vagina, may produce most disagreeable and disgusting odours; but they do not resemble that of cancer, which is sui generis, and which cannot deceive the clinical observer. It is yet more impossible to confound it with gangrenous miasmata. It is tainted (infecte) and nauseating, and distresses the patients themselves; while it oftentimes penetrates so far into the apartment, as to render it nearly uninhabitable, in spite of efficient ventilation." 621.
The internal use of the iodide of potassium, and the external application of the protonitrate of mercury, are often of great service in cases apparently desperate; and in most they procure at least alleviation and retardation.
Amputation of the Cervix Uteri.-This may be performed-1. When the cancer is well characterised, and extends too deeply to admit of the use of caustic. 2. When it does not extend above the superior portion of the uterine insertion of the vagina. 3. As some ulcers of the leg require amputation, so may ulceration of the cervix, though not carcinomatous, justify the operation when, from its utter obstinacy, it proves too much for the debilitated condition of the patient. 4. The fact of the uterus being in a state of hypertrophy or engorgement must not necessarily prevent the operation. 5. The performance of the operation is encouraged by the fact, stated by Bayle, and confirmed by the author, that cancer of the uterus is attended with far less implication of surrounding parts, or affection of the absorbent glands, than when it attacks other organs. 6. As in cancer in general, it is but a limited portion of the tumefaction which is specifically diseased. 7. Even very great increase
in the size of the ovaries must not necessarily prevent the operation. 8. Where the whole of the diseased portion cannot be removed, that which remains may be cauterised. But the author states that very indifferent success usually attends this, which he calls the mixed operation. 9. It is an error to suppose that much pain or hæmorrhage attends the operation. Many patients at its completion are not aware that it has been commenced, while the bleeding is often very inconsiderable and easy of arrest.
The operation does not prevent future pregnancy, and not only does the fœtus usually reach its full time, but the labour is terminated with greater facility of twelve persons who became pregnant, one only miscarried, and this was attributable to her own imprudence. In one case, twins, full grown, were easily delivered.
In one, only, among his numerous cases, has the author known the cicatrix produce obliteration of the os uteri.
Throughout his work, our author manifests a morbid sensibility as to the opinions of others concerning his statements, and a disposition to charge upon them the purloining of his discoveries and improvements in medical science. Upon the subject of amputation of the cervix uteri, he is especially sore. Our readers are aware, that the authenticity of his cases has been very generally disputed, both in France, and in this country; and that he has been charged, not only with performing the operation where no cancer whatever existed, and reporting it as cancer cured, but also with very much understating the amount of the mortality which has attended his proceedings. His defence in the present work is lame beyond conception. Instead of meeting his antagonists upon the questions of fact which they have adduced, he charges them with having obtained his documents (which, strange to say, he had himself prohibited the publication of,) surreptitiously from the Academy, and travestied their contents. He states, that, in his paper upon the subject, he merely declared that after 99 operations, 84 patients were cured, and 15 only died; but that he declines all verifications of such astounding results. "Professional honour imperiously forbids my doing so. I would not at any price betray the secrets of families. I will never foget the oath of Hippocrates." In answer to such evasive nonsense as this, we can only say, that M. Lisfranc has much over-rated the authority he supposes himself to possess in the medical world, if he thinks he can introduce an operation of this character into general use, without demonstrating, not only the ease with which it may be performed, but also the success that attends it; and that, not by mere assertions, but by authenticated facts. It is instructive to learn that he seldom now performs it himself. It is true that he explains this by the fact, that cancerous diseases are now so well ascertained, and treated in their earlier stages, (by the means he has introduced) that cases calling for operation comparatively seldom present themselves. The melancholy truth, however, forces itself upon our conviction that he has been deluded by the very ignorance of diagnosis he so bitterly blames in others, or by mere temporary success, into the performance of many most unnecessary and unjustifiable operations, until his rashness has been restrained, and he himself forced upon a more legitimate mode of proceeding, by the indignant voice of that profession, which
would have been but too well pleased to have followed his practice, and participated in his success, had the one been rational, and the other assured. Who is there believes, that the number of cases of genuine cancer of the uterus has been diminished materially by improvements in the mode of treatment of the disease?
Affections of the Fallopian Tubes and Ovaries.-One or both of the Fallopian tubes may become obliterated, sometimes through the whole extent of the canal, but usually only in limited portions of it. The affection may be congenital, or produced by compression, coagula, retained secretions, &c. It may result also from inflammation extending itself from the uterus or peritoneum. Sterility has often been observed in women who prior to marriage had been affected with metro-peritonitis, or who have subsequently suffered from it after accouchements; and by employing means adapted to chronic or acute inflammatory action, the author has frequently been enabled to relieve this condition. Inflammation of the ovaries sometimes follows a laborious accouchement, metro-peritonitis, &c.; and, when not proceeding from some such cause, it is a rare and usually subacute affection, very insidious in its progress and sometimes brought on by cold, emmenagogues, the abuse of sexual intercourse, &c. Antiphlogistics and the iodide of potassium are the chief remedies.
Magnetism.-Mr. Ward of Ollerton and his lawyer-operator must not imagine themselves the introducers of magnetism as an agent in surgery. Our author has the following passage.
Many affections of the womb produce violent sufferings, which even the muriate of morphia introduced by means of a blister fails to relieve. These pains, which manifest more or less of a neuralgic character, are remittent or intermittent, their exacerbations produce in the patient a state amounting to desperation, leading her sometimes into the greatest danger. The physician, finding he has exhausted the resources of his art, remains a mere spectator of these dreadful scenes whose termination cannot be foreseen. There is, however, a powerful means to which you must then necessarily have recourse, viz. magnetism. Far be it from me to admit the reveries of the magnetizers; but it is quite certain that Mesmerism produces a most extraordinary effect upon the nervous system of the women we are now alluding to. I have convinced myself of this a great number of times. I have seen the pains dissipated as if by enchantment." 725.
This volume, as we have said, concludes the present work; but others upon Operative Medicine are to follow.
"Ore trahit quodcunque potest, atque addit acervo."
Notices of some New Works.
PULMONARY CONSUMPTION, SUCCESSFULLY TREATED WITH NAPHTHA. By John Hastings, M.D.
DR. HASTINGS states, that the reason which induced him to deviate from that line of medical practice, which has so universally, and for so long a time, been in vogue, for that which he now brings forward, was the fatal termination of all cases, whatever was the treatment adopted, during an experience of upwards of twenty years.
From the greasy nature of tubercle in its crude state, Dr. Hastings concluded, that carbon entered largely into its formation, and that its composition had a striking resemblance to fatty matter. Among the changes in the earlier stages of pulmonary consumption, the disappearance of the fat is about the most remarkable; in consequence of this loss of fat, the author determined to employ those compound agents rich in carbon and hydrogen, which had not been previously used in medicine; "not with the idea that they would make up the deficiency which the system had sustained in the progress of the disease, but that such a change would by that means be introduced into the constitution as would act upon the forces of the organism at the point of departure from health, whether that took place in the stomach, blood, or elsewhere;-that change tending to such an affinity in the elements within the body, that the carbon, hydrogen, oxygen and nitrogen, instead of assisting in the formation of products which threaten life, would tend to develope those materials only which are required for the perpetuation of health, and the prolongation of existence."
Accordingly, Dr. Hastings was led to employ naphtha as a remedy in pulmonary consumption. Many different compounds pass under this name, but the kind of naphtha termed pyro-acetic spirit, obtained by the destructive distillation of an acetate, generally of lead or lime, and in its outward form scarcely distinguishable from pyroxilic spirit, is the species which is considered to be the best suited for this purpose.
The following is the way in which Dr. Hastings employs the remedy.
"I administer naphtha three times a day, in doses of fifteen drops for an adult, mixed with a table spoonful of water, which is proportionably decreased according as the patient approaches youth. After the second or third day, I increase the dose by about one-fourth; regulating its increase or decrease, according to the absence or presence of nausea, sickness, or any other untoward symptom arising out of its use. As the disease advances, I increase the dose to forty and even fifty drops, and administer it four times a day, instead of three
"The successful use of naphtha, as an internal remedy, induced me to try its effects by inhalation, to which I was the more inclined from the results of the following experiments :
"1st.-A little naphtha having been put into a bent tube, resembling the capital U, some expectorated matter was poured upon it, which had been determined with the microscope to be rich in globules of tubercle. Gentle heat was then applied, and the naphtha driven off, when the super-imposed secretion presented a mere shapeless mass of animal matter, the globules having entirely disappeared.
"2nd.-Some tuberculous secretion, highly charged with globules of tubercle, was placed under the field of the microscope, and a drop of naphtha added, when an immediate disappearance of the globules ensued, leaving behind a mass of the same character as on the former case. The frequent repetition of this experiment, invariably led to the same result.
"3rd.-Some tuberculous secretion of the lungs was put into a portion of the intestine of a child, and placed over a wide-mouthed bottle, which contained a small quantity of naphtha, between which and the intestine a clear space of three inches remained. A spirit lamp was then placed under the bottle, and a very gentle heat applied until slight ebullition took place, which was continued for an hour. The contents, when removed from the intestine and examined with the microscope, presented the same appearance as described in the previous experiments.
"Considerable benefit resulted from the inhalation of naphtha, in lessening the difficulty of breathing in the most advanced cases, in rendering muscular efforts less painful and fatiguing, and in a general alleviation of all those symptoms which distress the consumptive patient. The expectoration is not unfrequently rather increased immediately after the inhalation of naphtha, but the cough has changed for one of a milder character. Improvement was generally observed to follow that kind of inhalation which was performed with little exertion. It may be employed several times in the day, unless it produces nausea and sickness, when its use should be suspended; and on its being resumed, in such cases, it should be applied for a shorter period. When there is spitting of blood, its use is not admissible."
"Almost immediately after naphtha has been administered, an occasional rising of the medicine is perceptible in the mouth and throat, similar to that which occurs after a dose of castor oil. This is sometimes followed by nausea, and now and then vomiting supervenes. At other times it acts, but much more rarely, as an aperient. But when these effects occur, they usually subside in a day or two. It not unfrequently produces a glow in the region of the stomach, which extends over the chest and creates a sensation of cheerfulness and a greater freedom of breathing. It appears deserving a high rank among tonics; for in most of the cases in which it has been employed, a natural appetite was in a short time established. No remedial agent that I am acquainted with possesses such power over the colliquative perspirations of pulmonary consumption; as a few doses, in most instances, appeared sufficient to effect their removal. Another fact worthy of remark, is the absence of diarrhoea in all cases, which may be accounted for upon the supposition that tubercular deposit ceases to take place in the mucous track of the intestines. And even in those cases where diarrhoea, in the first instance, existed, it readily yielded to the naphtha treatment. The thirty-third case is a good example of this remark. Headache, particularly when the bowels are confined, is sometimes the effect of the naphtha treatment, and if aperients fail to give relief, a mustard poultice should be applied to the back of the neck, or a few leeches to the temples, or behind the ears. It will, however, be very seldom necessary to suspend the employment of the naphtha from this cause."
According to Dr. Hastings, from the very first moment he employed Naphtha in Pulmonary Consumption, up to the present time, it has been so successful in his hands, that he has no doubt it will be found, if used judiciously, to be little less than a specific in the earlier stages of the disease. And, from what he has