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Treatment of Puerperal ConvulsionsAuthor(s): Frederick CoxSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 8, No. 8 (May 22, 1844), pp.108-109Published by: BMJStable URL: http://www.jstor.org/stable/25497889 .

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108 CALCULOUS DISEASES.

without extracting the placenta, sewed up the wound, in the way practised on dead bodies. Dr. Morton, an

able practitioner, was sent for as soon as possible, and

saw her about three hours after the operation. He

considered the mode in which the wound had been

sewed up, as improper; had the stiches divided, directed the parts to be washed with warm water, and

the bowels to be cleansed from the straws and sand

which had adhered from their lying on the mat. He

easily extracted the placenta, replaced the intestines, and brought the lips of the wound together by the

interrupted suture. She had lost a great quantity of

blood, and was put to bed speechless, without any pulse at the wrist. Her speech she recovered on the following

day, but had a degree of fever some days longer, with

very little locbial discharge. From that time she went on well, and was able to sit up at the end of five weeks, had strength enough to walk in a fortnight more, and

in three months was perfectly recovered.

" Her mistress parted with her soon after this, but

Dr. Morton, to know the remainder of her history,

applied for information to a surgeon on the plantation to which she was removed. He received for answer

that she had been regular in her menstruation from the

time she had been under his inspection; had again become pregnant, and if she had not been carefully watched, would have chosen to repeat the operation,

having declared her sufferings from that to have been

trifling when compared with the pangs of child

bearing. Her labour was natural, and her recovery perfect."

Bridgewater, April 10, 1844.

PREVALENCE OF CALCULOUS DISEASES IN THE EAST INDIES.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL.

SIR, It seems as if diseases spring up wherever we look

for them, and that they are reported often to be absent in certain districts, because there is indifference in our profession as to their detection. I dare say, if a zealous litbotomist were to go' to Holland, he would find that calculous concretions of the bladder are not quite banished; yet we rarely hear now of the occurrence of this form of disease, so prevalent a century and a half since, as evidenced by Rau's numerous operations, and by the still existing museums of pathology formed about that time.

A few years ago it was affirmed that urinary concre tions were scarcely tobe metwith in the East Indies, and ihat when they did occur, the subjects were Europeans,

who took with them the germs of the disease from their native country. This opinion has been proved erroneous by the occurrence of every recent year, and surgeons now, being operators, find numerous occasions for exercising their skill in the east.

I offer these remarks, for the purpose of naming that i lately received a letter from Dr. J. Jackson, of

Calcutta, accompanied by a present of several cadculi for my cabinet, removed by operation, and I have the

pleasure of making public the follovinr extract:

"The subject of urinary calculus, and the improve ments which are taking place in Europe as to its treat

ment, are full of interest to us in this country, where

the population is so numerous, and the disease so

common, for the assertion made some years 'go by - , and repeated by the surgical professors-in my

time, that the disease did not exist in tropical climates

is very far from truth. In the midland provinces, and

in upper India, there are very few districts where the

disease is not prevalent amongst the lower class of

people, and it is particularly common amongst those

who are badly clothed, and who live upon an unleavened

wheaten cake, called chepattie, not unlike the Norfolk

dumpling. I am not aware if the treatment by litho

trity has ever been adopted in this country; there is

but little disposition to inflammatory action amongst a

people who feed only on vegetables and grain; so that the mortality is too slight amongst the young to call for any change, and the disease is rarely met with, as in England, amongst the aged."

The concluding remark of Dr. Jackson suggests to me one observation. In the aged, where disease of the prostate gland or bladder is so often the predis posing cause of calculus, it has been believed that

vesical calculi might'occur in any climate, and hence the aged were the class most liable to it within the

tropics. It would be very interesting to find Dr. Jackson's statement as to the malady in question being more prevalent amongst the young, and less amongst the aged, corroborated by other experienced surgeons.

I remain, Sir, Your obedient servant,

JOHN GREEN CROSSE. Norwich, May 13th, 1844.

TREATMENT OF PUERPERAL CONVULSIONS.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

SURGICAL JOURNAL.

SIR, Whenever any controversy takes place with regard

to treatment in any particular maladies, every case of

the kind must be interesting, in whatever way treated, as having a practical, and therefore valuable bearing on

the point at issue. As much has lately been written in

your valuable journal upon the treatment of puerperal convulsions, I send you the history of a case recently treated by me; and, as undeserved blame has been cast

upon Mr. Druitt for the mode of treatment pursued

by him, it will be seen, that in making my case public, I am not unwilling to share the blame with him; on

the contrary, I shall be most happy to be in his com

pany on this occasion, as it was my good fortune to be some years ago.

I was called up about two o'clock on the morning of Sept. 27th, to see a lady whom I expected to find in labour; such was not the case. I learned that she

had awakened suddenly in great terror, and, as she

said, with acute spasm in her bowels; the face was

extremely florid and swollen, the vessels of the neck and face were much distended, the pulse 90, hard and full. She complained of great pain in the head, especially over the left eye; I had a dozen leeches applied to the

temples, followed by a cold lotion, and applied sinapisms to the eyes, and gave a brisk aperient. In an hour or two she fell asleep, and when I called about 10 a.m,, she said she felt very well, and experienced no pain in the

head, nor elsewhere. About eight o'clock in the evening I was summoned to be informed that symptoms of

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PUERPERAL CONVULSIONS. 109 _ , 19

labour (this was her second accouchement) had shown

themselves; I slept in the house, but was not disturbed

the-whole night, her pains being so trivial and far

between. When I arose about seven o'clock, on the

28tb, I found my patient comfortable, but a little

fatigued; the face was still swollen, and the pulse fuller and quicker than natural to her. I had not left

herhalf an hour ere I was called in great haste, and

from the attack on the previous night, and the swollen

condition of the face and neck, I was almost prepared for that I met with. My fears were confirmed on

opening the door, for I heard the lady screaming

violently, madly, and found four or five attendants

trying, fruitlessly, to keep her in bed; the eyes were

glaring and furious, the whole face distorted, the mus

cular strength immense, breathing loud and stertorous; in fact she had puerperal convulsions. On making an examination, the os uteri was found to be dilated

to the size of half-a-crown, and the head presenting

naturally. I hesitated not to bleed, which I did from

both arms at once, but with great difficulty front the

smallness and depth of the veins., When 20 or 25

ounces of blood had been thus rapidly drawn, the

pulse sank, the rigid limbs became pliable and enfeebled, and appearances of syncope took the place of the

previous alarming symptoms. The child was born

(dead) without a seeming effort. Much to my surprise and delight my patient gradually became composed, but not sensible, for many hours. As soon as I could pre vail upon her to take it, I gave three grains of calomel, with ten of extract of colocynth, followed by an aperient

draught. I need not add the subsequent treatment, as all went well. Now, I ask, who would have doubted

the propriety of bleeding in this case ?-who would

have hesitated to bleed promptly and freely? I

firmly believe that had I abstracted blood from the

arm on the morning of the 27th, when first called, my

patient would have had no convulsions.

I merely send you this case in order, by a practical illustration of its value, to justify the treatmentpursued

by Mr. Druitt. My case bears a close analogy to Mr.

Druitt's in another particular, viz., that rather severe

salivation took place, and yet I gave only three grains of

calomel. I attribute this accident in both cases to the

facility with which mercury produces its peculiar action when administered after large blood-lettings.

I am, Sir, Your most obedient Servant,

FREDERICK COX.

Welford, Northamptonshire, May 17, 1844.

PROVINCIAL

^teicfal & surgical Sournal. WEDNESDAY, MAY 22, 1844.

When the social interests or the moral and reli

gious welfare of mankind are at stake, it becomes

the duty of the statesman and of the minister of

religion to raise their voices and exert their influ

ence in the common cause. So likewise when the

physical well-being of the community is endan

gered, it is incumbent upon the medical profession at large to warn the ignorant and incautious against

the threatened evil, and as far as practicable guard against or remedy its effects. Actuated by these views, \e are led to make a few remarks upon a

subject which has lately engaged the attention of the Conmons House of Parliament. We allude to the portion of time which should be allowed for continuous daily labour in the factory.

It is to be feared that many of those who have undertaken to decide upon this question, are but very imperfectly instructed in some of its most important bearings, and have been influ. enced in their decision rather by certain

abstract notions of political expediency, or by

party considerations, than by a knowledge of the

powers and capabilities of the human machine. We believe that of those who are best qualified to form a judgment,-of those who from education, study, and practical experience are best informed of the extent to which human endurance may be tasked without permanent injury, there are few

who would have ventured to come to a conclu sion upon it without the most careful and anxious

inquiry. Yet we do not hear that the opinion of eminent persons competent to arrive at a just con elusion in the real merits of this part of the subject has been either sought or listened to by the many who have recorded their votes in favour of the long period.

No mere legislator, however intelligent he miay be in questions purely political, or whatever may be the powers of his mind, can be supposed capable ~of exercising those powers with effect in a subject of the details of which he is in entire ignorance. An engineer who is well acquainted with the dura

bility, toughness, elasticity, and other physical properties of the wood and metal employed in the construction of machinery, and with the

wear and tear from friction and other causes to which this machinery is subject, may be able to estimate its powers, and regulate the

employment of it, so as to produce the greatest pos sible effect at the least possible disadvantage. But were it necessary or advisable so to economise

machinery as to render the preservation of it a

subject for legislative interference, would the

Government, or the Members of the House of

Commons, proceed without due investigation, in which the opinion of eminent engineers should have full weight and consideration. But the pre servation of the human machine, regarded merely as such, as it is too apt to be in discussions of this

nature, is to this full as important for the good of the state, and is now actually under consideration. Can it be considered consistent with that wisdom, and those principles of sound government which the country has a right to look for from its legis

lators, that the construction, the wonderful play of action, and the modifications which both

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