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"It is probable that this gentleman had actually ascended to the top of St. Paul's, and that impressions there received being after. wards renewed in his mind when in a state of vivid excitement, in a dream of ecstatic reverie, became so blended with the creations of fancy as to form one mysterious vision, in which the true and the imaginary were afterwards inseparable. Such at least is the best explanation of the phenomena that occurs to us." (P. 37.)
DR. BISSET HAWKINS, in an article on Medical Statistics, says, "The proportion of births to a marriage fluctuates in different countries: in England it is about four births to a marriage; at Paris the proportion is scarcely 2.44 births to a marriage; while in some villages in Scotland it is so high as seven. We doubt if the proportion varies much in different countries, though it may in different towns or villages. Throughout Europe, we believe, the proportion is four and a fraction to a marriage; it is the fraction only which varies.
DR. WILLIAMS has an account of the Stethoscope, considered as an instrument; the diagnostic signs derived from it having been discussed under the head Auscultation. The following remarks will interest many of our readers:
"Our limits do not permit us to describe other forms of stethoscopes that are to be met with. In all those which we have seen acoustic rules are sacrificed to portability or elegance. That of M. Piorry, which is commonly used, is faulty in having the conducting power of the wood impeded by screws and a thick cap of ivory; besides which, the excavated end is generally very ill fitted. Although, when unscrewed, more portable than the other instrument, the trouble of screwing and unscrewing the several parts is enough to counterbalance this advantage. Our friend Dr. Stroud uses a caoutchouc tube, with an ivory funnel attached, like the flexible hearing-trumpet. The flexibility of this instrument is certainly an advantage, but it is obtained at a great sacrifice of intensity and distinctness of the sounds, in consequence of the imperfect and irregular reflecting power of the interior of the tube. This flexible stethoscope separates the sound from the impulse of the heart more completely than any other. Although, for general purposes, the common stethoscope fulfils sufficiently well its triple office, it might be well for the attainment of greater accuracy in physical diagnosis, if auscultators in hospitals would use separate Instruments for the three classes of signs. 1. A solid cylinder of wood for the auscultation of the heart. 2. A metallic tube, half an inch in diameter, furnished with a wood or ivory ferule at the pectoral, and an ear-piece at the other end, for the investigation of the respiration and vocal resonance of small spots. 3. A metallic tube, like the last, but with its pectoral end expanded into a tapering cone, for the same purposes as the stethoscope without the stopper. After a little practice, we have little doubt that these
instruments would be more powerful aids than the common stethoscope, but we do not pretend to recommend them for general adoption." (P. 68.)
Dr. A. T. THOMSON, in a judicious paper on Stimulants, recommends the use of the ioduret of iron. After observing, that the iodurets of mercury and lead must be given even in smaller doses than iodine itself, he says:
"On the other hand, the combination with iron, which was introduced to the notice of the profession by the writer of this article, diminishes the irritative action of the iodine, whilst the iron being rendered soluble, and in a state to be readily converted into the protoxide, is carried into the habit with the iodine, and aids its deobstruent influence by giving tone and support to the system.* It is admirably adapted for chlorotic affections, and cases of glandular obstructions, connected with diminished power and a leucophlegmatic state of the habit. On account of its deliquescent property it cannot be administered in substance; and when dissolved it is converted into a hydriodate, in which form it may be administered in doses of from two to six grains three times a day. The influence of both its components is rapidly visible on the habit by the improved colour of the skin, the increase of appetite, exhilarated spirits, and invigorated strength of the patient; and so quickly does it get into the system, that in twenty-four hours after the first dose has been taken, both the iron and the iodine can be detected in the secretions. It is incompatible in prescriptions with alkalies and their carbonates; the metallic salts; all vegetable infusions and decoctions containing tannin and gallic acid; the preparations of opium, henbane, and conium; the alkaloids and their salts, and chlorine. It has one advantage over all the other preparations of iodine, it does not produce emaciation, or that wasting of glandular bodies, which renders the closest watchfulness requisite in their administration." (P. 79.)
Several other articles merit commendation; and, on the whole, this number is a good one.
We must not omit to mention, that the editors say that a fourth volume "is found necessary to the completion of the undertaking." Thus it is that the illaudable practice of publishing books in fragments leads to prospectus-breaking.
"The ioduret of iron is prepared by placing one part of soft tempered ironwire in a hollow porcelain vessel with a considerable quantity of distilled water, and adding five parts, by weight, of pure iodine, and then subjecting the mixture to heat, constantly stirring until the solution is accomplished and the liquid is nearly clear. The solution is then to be filtered and immediately evaporated to dryness in a flask, which must be broken as soon as the ioduret has crystallized, and the preparation directly put into a well-stopped phial. It is a proto-ioduret, containing one equivalent of each of its components. When well made, and well preserved from the air, it dissolves entirely, and affords a pale greenish-yellow solution; but when not well preserved from the air, a portion of the iron is converted into the peroxide of the metal, and a sesqui-ioduret is formed, so that when it is rubbed up with water the peroxide remains insoluble."
Die Geburtshilfliche Exploration. Von Dr. ANTON FRIEDRICH HоHL, ausserordent lichem Professor an der Universität zu Halle. Erster Theil: Das Hören.-Halle, 1833.
On Obstetric Exploration. By Dr. HOHL, Extraordinary Professor in the University of Halle. Part the First: On Hearing.Halle, 1833. 8vo. pp. 314.
IN studying obstetric auscultation, a department of the art of medicine which is confessed on all hands to be very difficult, and is thought by many to be very dubious, it is satisfactory to have the testimony of a witness like the author before us, who is not content with giving his conclusions, but details in the minutest manner the facts upon which they are founded. We have therefore thought it our duty to give a succinct abstract of the work before us, which bears every mark of being the composition of a faithful and zealous observer.
Passing over a good deal of prefatory matter, we come to a chapter entitled "Results of Auscultation in Healthy Women not Pregnant, in Lying-in Women, and in some diseased States of the Abdomen." In some women, says our author, nothing is to be heard but the rolling of gaseous or other fluids; in others, (but they are a minority,) a pulsation is to be heard at the summit of the abdomen, belonging rather to the heart than to the aorta. There is no soufflet, however, but a pulsation isochronous with the beating of the heart; the beats are sharply broken off, and no whirring is to be heard between them. In the right part of the upper region of the abdomen, at the left lobe of the liver, a beating may also be beard: this belongs to the tripus Halleri. At the lower and left side of the abdomen another pulsation may be perceived, accompanied by a soufflet: this may proceed from the left iliac artery. It is probably caused by the left iliac artery lying under the vein of the same name. The sound is not heard on the right side.
The flow of the catamenia produces no change in these sounds, nor is any alteration caused by pressing the abdominal parietes.
In lying-in women the above-mentioned pulsations can be perceived, but there is another one in addition. When the uterus is very high up, or even if it is in its ordinary situation, but has not yet perfectly contracted; and there are strong after-pains, a faint humming sound can be heard in that part of the uterus where there was a strong soufflet during pregnancy and parturition; this is almost imperceptibly increased at each beat of the pulse, and follows each pulsation of the heart for an instant.
When there is disease in the abdomen, these rules of course no longer hold good.
When, for instance, the liver was very much enlarged, Dr. Hohl found a pulsation in the right hypochondrium isochronous with the beating of the heart, and the intervals between each beat were filled up with a faint, uniform, obscure soufflet. In a case of fungus medullaris, filling up the whole epigastric region, several mesenteric glands were much enlarged; there was a great accumulation of fæces from obstinate costiveness, and the abdomen was very tense. Here Dr. Hohl was not able to hear the sounds above described; for, to use his own words, "es herrschte eine Todtenstille in der Todbringenden Höhle:” i. e. the stillness of death reigned in the deathproducing cavity.
In a case of degeneration of the left ovarium, which was taken for pregnancy, our author was unable to hear the pulsation of the iliac arteries. The pulsation of the heart and the cœliac artery could be heard, but not so distinctly as in healthy persons.
In ascites accompanied by tympanites, when our author applied the stethoscope, and gently struck the opposite side, a sound was produced not unlike that of a distant drum. If the abdomen is struck more forcibly, the fluctuation of the water causes a sound something like snoring. The normal sounds are either not heard at all, or there is merely a faint pulsation of the iliac artery.
In aneurism of the aorta there is a strong pulsation and a soufflet. This soufflet, however, is monotonous, and especially perceptible on the left side.
We now arrive at the phenomena which occur in the auscultation of pregnant women.
There are two pulsations peculiar to the gravid state: the one is isochronous with the woman's pulse, the other is much quicker. The first, while it resembles the ordinary pulse in frequency, differs from it in the quality of sound; the latter, on the contrary, has more resemblance to an adult's pulse, excepting in its frequency. It is dicrotic, or doubly beating, and one may count 216, 240, 244, 256, 260, 268, 272, very often 280, not unfrequently 320, 326, nay even 350 single beats; or, what is the same thing, 108, 120, 122, 128, 130, 134, 136, 140, 160, 163, or 175 double beats. This is the fœtal pulse, and its presence or absence determines the life or death of the foetus.
The isochronous, or placental pulsation, is usually to be heard at the upper and back part of the uterus, especially in first pregnancies. The dicrotic pulse is generally heard
towards the left side of the uterus. The placental pulsation has never been heard by Dr. Hohl before the fourth month: it is then much diffused, but in the fifth month becomes concentrated in a single spot. As pregnancy advances, it often becomes weaker and weaker, but never disappears entirely. Nor has our author ever heard the dicrotic pulse before the fourth month; even in the fifth it is weak, and does not become very plain till about the end of the sixth month. In some cases Dr. Hohl could not hear it a short time before the commencement of labour, and in others it disappeared earlier, and in one case it was imperceptible for four weeks before delivery.
The placental pulsation is isochronous, as has been already stated, with the mother's pulse, while the dicrotic pulse is uninfluenced by it.-Our author gives a number of cases to prove this, but we shall content ourselves with quoting the first two.
1. The radial pulse of a pregnant woman was 67 in the horizontal position, 74 when she sat up, and 94 when she stood. The same alterations took place in the placental pulsation, but the dicrotic pulse remained without variation at 140 double beats.
2. The radial pulse of another pregnant woman was 104 when she stood, from 88 to 90 when she sat, and 82 in a horizontal posture. The placental pulsation participated in these changes, but the dicrotic pulse always remained at 132 double beats.
Dr. Hohl, however, is of opinion that the temperature of the mother exercises an influence on the fœtal pulse, the beats being more numerous in proportion to the increase of the heat; and he inserts a long table of observations to prove this. Moreover, when the function of respiration is injured, and the arterialization of the blood is in consequence diminished, the dicrotic pulse loses in frequency. This is especially the case in the earlier months of pregnancy,-that is to say, from the fifth to the eighth month. And hence the diseases of the mother will affect the dicrotic pulse, or not, according to their nature. Thus, in cases of rheumatic fever, or of rheumatism affecting the muscles of the head, abdomen, or extremities, no alteration was perceptible in the dicrotic pulse; but, where the muscles of the chest were affected, or when it was a case of pleurisy; in short, when respiration was encroached upon, this pulse became feebler and slower. The following case is a remarkable one:
A woman of disordered mind had made attempts to strangle herself, so that blood had flowed from her mouth and nose,