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eases, and, above all, the cause which pro-duces one of them, will generally enable usto draw a distinction.The cause of scurvy is always, I believe,

a want of fresh animal and fresh vegetablefood. This cause did not exist in the caseof Louis Charpeutier, or in any of the othercases of purpura treated by acids at theEnfans Malades, and its absence, indepen-dently of other reasons, furnishes a strongpresumption that the cases alluded to werereally cases of purpura, and not cases ofscurvy. I have the honour to be, Sir, &c.,&c.

P. H. GREEN.Paris, Sept. 10,1837.

P. H. GREEN.

CSAREAN SECTIONAFTER DEATH OF THE MOTHER.

By WM. DAWSON, Esq., M.R.C.S., Lectureron Midwifery at the Newcastle-upon-TyneSchool of Medicine and Surgery.

Mrs. B., aet. 23, of a nervous temperament,advanced in pregnancy seven and a halfmonths, was attacked (four months since)with severe pain in the bead, attended withdilation of the pupils, constant vomiting,convulsions, &c., which resisted every modeof treatment adopted by three medical prac-titioners. She gradually became weaker,and the convulsions more frequent. OnFriday, the 25th of August, last, she died,after a severe convulsive attack. I saw herimmediately afterwards, and, on placing myhand over the abdomen, felt a distinct mo-tion in the uterine region. With the viewof saving the life of the foetus, I obtainedpermission from her husband to open thebody. About a quarter of an hour afterdeath, I made an incision through the abdo-minal parietes, in the line of the linea alba,from the umbilicus to the symphysis pubis:this exposed the uterus, lying rather to theleft side of the abdomen, and presentingthe appearance of an immense congeries ofvenous sinuses. I made a similar incisionthrough the anterior wall of the uterus,(which was very soft, and about a line anda half in thickness): this laid bare themembranes, and divided a portion of theplacenta, from which a quantity of blackblood immediately flowed. The membranes were ruptured, and the foetus was foundlying with its face towards the back andleft side of the mother; the breech at thebrim of the pelvis. It was carefully re-moved. It was of small size, with a paleand flaccid skin. The heart was acting, andthere was pulsation in the umbilical chord.It was immediately introduced into a warmbath, and artificial respiration produced bymeans of the tracheal pipe. The action ofthe heart, and pulsation in the chord, con-

tinued for about twenty minutes, and thenceased. All our efforts, persevered in fora length of time, could not restore it.

This case was very unfavourable for thesuccessful performance of the (Jmsareaasection after the death of the mother. Thepatient had laboured under a chronic aflec,tion of the brain for four months, duringwhich time she vomited almost every parti.cle of food that was taken into the stomach,This, in conjunction with convulsions (oc,curring daily for the last six weeks), andrepeated fits of despondency, together withthe remedies employed to relieve the brain,reduced her to a state of extreme debility,and, consequently, materially interfered withthe nutrition of the foetus. (Several of herrelatives have died from a similar affection.)The case is interesting, in so far as thatthe foetus was found alive a quarter of anhour after the death of the mother, and,under more favourable circumstances, it isprobable that it would have been saved,The urgency of the case precluded me fromobtaining the stethoscope ; and although inthis instance examination by the hand wasperfectly satisfactory, yet I have no doubt,when signs of life are more obscure, that itsapplication would be invaluable in ascer-taining their presence, as judiciously sug.gested by Dr. Kennedy.

Newcastle-upon-Tyne,Sept. 11, 1837.

STRANGULATED SCROTAL HERNIA,CONGENITAL.

OPERATION,CURE.

WILLIAM LAMBTON, M.K.C.S.L.

To the Editor of THE LANCET.SiR :I beg to transmit to you the details

of an interesting case of strangulated scro-tal hernia, on which I operated, and shouldyou consider them worthy of a place in yourwidely-circulating Journal, you will confera favour on me, by giving them an early in-sertion. You will observe from this case,that however hopeless an operation mightappear, still it is the bounden duty of thesurgeon to urge his patient to accept thechance, which an operation alone can afford,of being rescued from the grasp of death.I am, Sir, your constant reader and obedientservant,

WILLIAM LAMBTON, M.R.C.S.L.96, Sloane-street, Sept. 1, 1837.

John Vine, mta.t. 28, servant to a farnter,residing near Cranbrook, Kent, strong, of ro-bust constitution, has been subject to herniaon the left side since the age of 19. (Thetesticle on the laemaiu side had necer descend.ed.) He states that the rupture had alwaysbeen reducible; that since its first appear-ance he has been in the habit of wearing atruss, but has occasionally left it off for twoor three days together, but that the least

29

exertion always brought down the hernia,which he could with facility return himself.He has laboured under no positive iiicoilve-nience until the 16th of July last, when, inusing violent exertion, in turning a cart-horse, he felt great pain in the left groin,which, as he terms it, doubled him up."Had no truss on at the time : he was obligedto be assisted home, and Mr. Ranger, ofCranbrook, his medical adviser, was imme-diately sent for.On examination Mr. Ranger found that a

large portion of omentum, and some hardsubstance at its posterior part, had descend-ed into the scrotum. The. taxis was resortedto without effect; he was then bled copi-ously, placed in the warm bath, and thetaxis was again resorted to, but still with-out effect. Small doses of antim. tart. wereexhibited, and every thing that could bedone proved fruitless. Castor oil 3j. wasadministered at bedtime.

July 17. Complains of great pain aboutthe abdomen ; pulse, 90, hard ; had hiccoughand vomiting during the night; countenanceanxious ; had no motion; the tumour nowwas about double the size of a hens egg,and inobedient to the taxis. A purgativeenema was administered, without bringingaway any feculent matter.Twelve oclock, A.M. An operation was

proposed, but the patient would not listento the suggestion. In the course of theafternoon he was again spoken to on thesubject, and he stated that a neighbour ofhis who had undergone the operation toldhim, that if he had his time to go overagain he would die rather than submit toit." Although from day to day the symp-toms became more and more alarming, andthe necessity of submitting to the operationwas most strenuously urged ; he still obsti-nately refused. His stomach could retainnothing; the constant hiccough and the gulp-ing of bilious matter, together with the con-stipated state of his bowels, which had notbeen moved for thirteen days, proved thatwhat ought to be done should be donequickly.

Dr. Jobson, of Cranbrook, was now sent for, and I accompanied him ; one glance atthe patient was suflicient ; the glazed eye,the convulsive hiccough, the great tensionof the belly, showing some of the convolu-tions of the intestines, and that peculiaranxious countenance which is so diflictilt tobe described, strongly indicated the ap-proach of death. All the entreaties of Dr.Jobson proved unavailing, and we returnedhome in despair. At eight oclock, P.M.,Dr. Jobson, who was most anxious aboutthe case, held a consultation at his house, atwhich were present Messrs. Ranger, Corke,Hicks, and myself. It was resolved thatwe should immediately repair to the patient,and use our utmost endeavours to persuadehim to submit to the operation: it was not.

however, until after long and repeated en-treaties that he at last consented.

Opaation,After shaving the hair fromthe pubes, I proceeded to make my first in-cision, from the upper part of the externalabdominal ring, carrying it downwards,through the integuments, to nearly the fun-dus of the tumour. After dissecting care-fully through the different layers of fascia Iopened the sac, and evacuated about ,iij ofa dark-colonred fluid. I then proceeded toexamine the contents of the sac, and be-sides the omentum and a knuckle of intes-tine, the testicle, which had never before de-scended, was contained in the sac. It wasabout the size of a hazel-nut ; the partswere still healthy: the veins of the omen-tum were partially congested. After divid-ing the stricture, which was at the neck ofthe sac, and breakiug down the adhesions,I returned the whole into the cavity of theabdomen, and brought the parts together bysuture. An anodyne was administered tothe patient, and he was put to bed.

30. Passed a tolerable night; had no re-turn of the hiccough after the operation.At between six and seven oclock this morn-ing, had a free evacuation from the bowels ;pulse 120; v. s. 3xij.R Olei ricini j. ; olei menth. pip. 5ss. ; ;

ft. haust. Hora somni sumend.31. Slept well; passed fluid stools, and

much flatus per anum ; no return of hic-cough ; slight thirst; pulse 90; countenancegreatly improved.August 1. Dressed the wound; scrotal

portion nearly healed ; slept well; bowelsopen; countenance cheerful; pulse 75, soft,and compressible ; tongue clean and moist.

2. Wound looking healthy ; complains ofhunger; allowed tea and toast; pulsegood ; bowels open; saBs s he feels quitehappy, and is anxious to be allowed more toeat. Since this time he has been graduallyimproving ; aperients administered when re-quired.

6. Wound quite healed ; he says that henever was in better health than he is at pre-sent.His improvement since has been gradual,

and, from a letter which I received yester-day, from Cranbrook, Vine is now able toresume his business.

PERIOD OF FIRST UNION OF

THE SIAMESE TWINS.

Dr. COSTE, favourably known by hisworks on Embryology, some time ago ad-dressed a note to the Academy of Sciences,Paris ; in which he examines the followingquestion :-

.

Is it possible to determine the epoch ofthe intra-uterine life, at which the Siamesetwins were united, and to explain the man,ner of their union ?

.