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and the sugillation caused by the cord was visible on her neck for days afterwards; the same night she threw herself into the water, and was restored to sensation with some difficulty. In this case auscultation was the means of consoling the mother, by affording the certain assurance that the child was still alive.

When the stethoscope is applied during labour, a great variety of tone is detected in the placental pulsation: it is stronger, and this increase of energy is especially perceived just before the commencement of a pain. This does not augment the frequency of the dicrotic pulse, nor is this altered by the increased temperature of the woman during labour. Thus, Dr. Hohl found that in several women, between the first stage of labour and the end of the third, the temperature rose to 32° of Reaumur (= 104° of Fahr.), and their pulse became 116, 120, or 124; but the dicrotic pulse kept steadily at 276. In others, in whom the temperature during the third stage of labour was 31° of Reaumur (= 101 of Fahr.) and the pulse 112 or 116, the dicrotic pulse was from 280 to 288. The placental pulsation varies with the pains, attains its acme with them, and diminishes in frequency as they gradually go off: and thus the placental pulsation, or, what comes to the same thing, the radial pulse, denotes the character of the pains by its regularity or irregularity, by its attaining or not attaining the desirable frequency, and so on.

Dr. Hohl gives numerous examples of the character of the pains, as indicated by the pulse. The following was an instance of regular pains, and the numbers denote the beats of the pulse, and the placental pulsation, in each quarter of a minute.

C. Albrecht. At the beginning of the second stage of labour: 27. 27. 27. 27. | 27. 28. 28. 30. | 31. 33. 31. 31. | 30. 28. 27. 27. | 27. 28. 30. 32. | 32. 33. 31. 30. | 30. 30. 28. 27. 27. 27. 27. 27. 27. 27. 27. 27. | 27. 28. 30. 33. | 31. 28. 27. 27. | 27. 27. 27. 27.-27. 27. 27. 27. | 27. 26. 26. 27. | 27. 27. 27. 26. | 26. 27. 27. 27. | 29. 30. 32. 32. | 30. 28. 27. 27. &c.

In the middle of the second stage of labour: | 27. 29. 29. 30. | 31. 31. 29. 27. | 27. 27. 27. 27. | 27. 27. 27. 27. 27. 27. 27. 28. 29. 30. 31. 31. 32. 29. 28. 27. | 27. 27. 28. 29. | 27. 27. 27. 28.-28. 28. 29. 30. 31. 33. 29. 27. 27. 27. &c.

At the end of the second stage: 28. 28. 29. 30 | 31. 28. 27. 27. 28. 29. 30. 30. | 28. 28. 27. 27. | 27. 29. 30. 31. | 33.29. 28. 27.

The pains were regular, but did not follow one another too

rapidly, and they lasted for a tolerable time. As long as the pulse was only 27 in a quarter of a minute, the woman was perfectly quiet, and she was tranquil even when the number was 28. At this point the moaning began; at 28 the bag of membranes was slightly advanced, but did not become quite tense till the pulse was 31 or 33 in the quarter of a minute.

We cannot afford room to quote the other cases, but will just mention that Dr. Hohl has constructed some diagrams of very quaint appearance, to shew the pulsations accompanying regular and irregular pains. The following diagram, for instance, exhibits the state of the pulse when the pains are too rapid and stormy, and allow the woman no repose:



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Dr. Hohl speaks favourably of the secale cornutum: he finds that, after a few doses, of ten grains each, the placental pulsation is increased both in strength and frequency. The secale, however, must not be old, and must have been well kept.

Dr. Hohl deduces the facts that the soufflet belongs to the placental pulsation, and the dicrotic pulse to the fœtus, from a great number of facts and arguments. Thus, to confine ourselves to the former point, the soufflet is never heard in those who are not pregnant, and always heard in those who are; it is generally on the right side, rarely on the left, and still more rarely at the lower part of the uterus; thus following the more usual positions of the placenta. When, however, the placenta presents, the pulsation is heard at the lower part of the uterus; but it is fainter in this case, as this part of the womb is less strong, and so likewise are the vessels belonging to it. This is a very interesting part of Dr. Hohl's work, but to give an analysis of it would lead us beyond all reasonable limits, and we must therefore content ourselves with referring our readers to the original, p. 141-181.

We now come to our author's account of the advantages to be derived from auscultation in the practice of midwifery. The first point achieved by auscultation is the determining cases of doubtful pregnancy. In discussing the uncertainty of the ordinary signs, Dr. Hohl narrates a very remarkable case, which we shall endeavour to abridge. A servant girl

complained of morning sickness, want of appetite, lassitude, and absence of the catamenia. A physician was called in, who did not examine her, as he was quite satisfied that she was pregnant, particularly as the breasts had now increased in size, and become painful. Additional symptoms soon made their appearance; she complained of bearing down, and shooting pains in the lower part of the pelvis. The physician now made an examination, and, finding the abdomen distended, the vulva like that of a pregnant woman, the os uteri round, and the uterus larger, he again affirmed it to be a case of pregnancy. The girl, being dismissed from her place, was brought to Dr. Hohl, and confessed that the breasts were larger than formerly, and the areola darker. On examination, the external marks of virginity were present; the os uteri was almost round, and not perfectly closed. From these, and a number of other signs, as well as from auscultation, our author pronounced it to be a case of retroversion and descent of the uterus, accompanied by an inflammatory state, with swelling, and commencing induration.

The treatment consisted in cold injections, and the following powder at night: R. Opii, gr. ss.; Camphoræ, gr. ij.; Potassæ Nitr., gr. iij.; Sacch. albi, 9ss. In a week the patient was considerably relieved, and went back to her former situation. The catamenia now returned, and no one ventured to talk of pregnancy.

Dr. Hohl mentions a case which occurred in 1824, in which Lenormand, by means of the stethoscope, detected a pregnancy, which up to the seventh month was supposed to be a scirrhus of the right ovary.

The next point to be ascertained by the stethoscope is the number of children contained in the uterus: when there are twins, the placental pulsation is far more diffused than usual, and when there are triplets, the sound extends over a still greater space. Dr. Hohl has stethoscopized one case of triplets, and observes that he could tell that there were more than two fœtuses, but could not tell exactly how many; just as, if we listen to the ticking of two watches, we can tell that there are two, but, if a third is added, we can distinguish that there are more than two, but not how many more.

Auscultation is also capable of distinguishing extra-uterine pregnancy. This may be of two kinds. The first is when it exists in the ovarium, the fallopian tube, or the substance of the uterus; the second is when its seat is in the abdomen. But, supposing it to belong to the first class, auscultation will not farther inform us to which subdivision it must be referred.

The existence of pregnancy in the substance of the uterus has been attested by Schmitt, Hederich, Albers, Carus, and Breschet, (Medico-Chirurg. Transact., vol. xiii. part i. p. 33); and some light seems to be thrown upon its progress by a case given by Baudelocque. A woman, who had never had children, died of pleuro-pneumonia in her fifty-third year, and he found a canal in the substance of the uterus, which communicated above with the right fallopian tube, and below with the neck of the uterus. As a placenta is formed in cases of extra-uterine pregnancy, they will be discovered by the usual soufflet being heard in an unusual situation.

As the accoucheur improves in obstetric auscultation, he will be enabled to ascertain the exact position of the fœtal heart, and to deduce from it the position of the head, &c. This is theoretically done by our author with great ingenuity, p. 236-252; but we must confess that the diagnosis seems to us to be a matter of such exquisite nicety, that we fear that centuries of obstetric stethoscopy, or rather cœloscopy, must pass away, before these refinements can be relied upon in practice.

It has always been a desideratum to determine the life or death of the fœtus during childbirth, chiefly of course with reference to the dreadful operation of embryotomy. The occasional fallacy of the ordinary tests of the death of the fœtus is known to every one; perhaps auscultation may furnish a better diagnostic sign. Dr. Hohl lays down the following rule: The foetus is dead, if the placental pulsation is very faint, or altogether inaudible; if the beating of the fœtal heart cannot be heard in any part of the abdomen, not even when the pregnant or parturient woman is placed in every possible position; and if a deep stillness reigns in the lifeless uterus. Dr. Hohl then considers auscultation in reference to some operations; namely, the bringing on premature delivery, perforation, the Cæsarean operation, turning, and the application of the forceps. He then has a few remarks on the advantages to be derived from auscultation in the treatment of the placenta: when it is retained, the soufflet will point out its exact situation. Dr. Hohl has injected aqua oxymuriatica (solution of chlorine) into the uterus to induce its contraction in cases of hemorrhage and retained placenta. This injection must, we fear, be a very dangerous one; it can hardly be justifiable to introduce a powerful stimulant into the uterus at a time when it is already so prone to inflammation.

Dr. Hohl concludes with some observations on the use of

auscultation in cases where the newborn child is apparently dead.

The present work is to be followed by two more, on other branches of obstetrical exploration. Should they be equal to the one of which we have just given an imperfect sketch, they will be alike useful to the profession, and honourable to their distinguished author.

A Treatise on Diseases and Injuries of the Nerves. By JOSEPH SWAN. A new Edition, very considerably enlarged.-London, 1834. 8vo. pp. 356, and ten plates.

In our last number we had the pleasure of giving some account of Mr. Swan's method of demonstrating the nerves of the dead; we have now the greater satisfaction of analysing his treatise on those morbid affections whose seat is in the nerves of the living. In this, as in the former work, Mr. Swan, to use a familiar expression, is quite at home, and every page shews the mastery of a great subject which may be attained by an acute mind studying it through a long series of years, with an attention proportioned to its importance. Our author's style is that of a man who can well afford to despise ornament; it is characterised by an antique simplicity, the internal evidence of the accuracy of the facts narrated. This excellent treatise is indispensable to every one who wishes to acquire a sound knowledge of the subject to which it relates; nor will the future historian of the diseases of the nerves, however brilliant his talents, however vast his acquirements, be justified in passing over the researches of Mr. Swan: it will be long indeed before they are obsolete.

The first chapter treats "of painful affections of nerves in general," and commences in the following manner:

"The nerves most subjected to painful affections are the fifth, and those arising from the whole length of the spinal chord. It may be expected that I should state whether pain be felt only by the posterior bundles of the spinal nerves, which have been termed sensitive, and not by the anterior, or those termed muscular. When a muscular nerve is irritated, an immediate contraction of the corresponding muscle takes place; it must therefore be endowed with perceptibility; but whether this be cognizable by the mind as a sensation in the common acceptation of this quality, is very difficult to determine; nor is it less so whether its morbid condition be productive of pain. The facial portion of the seventh pair of nerves conveys the power of action to many of the muscles of the face, but is subjected to painful sensations. Experiments

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