« ForrigeFortsæt »
This would yield the enormous number of three hundred millions in a cubic inch of the vital fluid.
It is not our province to settle the question of how many are required to vivify the ovule; suffice it to say, whether one or many, by this great number a beneficent Creator has put the chances for procreation beyond a peradventure.
WAYNE GRISWOLD, M. D., CIRCLEVILLE, OHIO.
December 8th, 1868–Was called to see Miss W. While holding a chicken for her brother to kill, a misdirected blow of his hatchet cut off the end of her thumb, taking the entire pail, about one-third of the first phalanx and the entire ball of the thumb. On asking for the piece of thumb, they informed me that it was rolled up in a cloth out in a cold room, and that it had been one hour and three minutes (by the clock) since the accident. The mother was in great tribulation at the prospect of a deformed thumb for her young daughter, and the child was still more worried for fear she would not be able to play octaves on the piano. After washing the thumb in warm water till it bled freely, and warming the piece in the same manner, it was placed as near in position as possible and secured by adhesive straps. Left orders to wet the thumb (in a warm weak solution of carbolic acid in water) every few hours.
On the third day, removed the dressing. The parts adhered, but the nail looked blue and the skin white and dead. Dressing continued.
On sixth day, removed the dead skin and with it the phalangel bone. The ball of the thumb looked like a piece of fresh beef covered with purulent matter. Found by examining with a glass, a new nail starting. Continued the carbolic acid dressing.
The old nail came off in fifteen days; a new one took its place, leaving the thumb perfectly natural except a little flatness of ball from loss of blood. There is not a scar to mark the place where the thumb was injured. New skin formed from the stump up over the ball, smooth as it ever was. The mother was left to rejoice that her daughter had no thumb deformity and was again able to play the piano as well as she did before the injury.
MYXOMA, OR HYPERPLASIA OF THE VILLI OF THE
BY ALEXANDER D. SINCLAIR, M. D. Member Massachusetts Medical Society, American Medical Association, Obstetrical Society of Boston, &c. Re-printed from Vol. 1, No. 1, of the publications of the
Massachusetts Medical Association.
A little brochure of three pages, on a very old subject, with a very
The first page relates to the rarity of the affection; the second, the history of the case; and the third and last describes the remarkable phenomena.
“Mrs. æt. forty, mother of seven living children, youngest about four years old, aborted after her first and fifth conceptions, about the third month.
Catamenia regular with some pain, were last present on January 27th, 1868.” Pregnancy, “May 10th, she noticed for the first time her linen slightly stained with a somewhat bloody matter, which appeared at intervals for the next four days, with a slight pain occasionally felt in the uterine region.
Near midnight, on May 14th, "she was suddenly seized with an alarming hæmorrhage, causing her to faint and become pale as if dead. She had recovered her senses before I arrived, but the pallor which remained, together with the appearance of the bed on which she lay, bore evidence of a frightful loss of blood.
“On examination, the uterus felt like that of a woman in the fifth month of pregnancy
The os rigid, though sufficiently dilated to admit the index finger; hæmorrhage had ceased. Careful examination of the clots discovered only a small fætus, having the appearance of full three months growth.”
A tanpon was introduced and ergot administered, restoratives, &c.
"This dilated the cervix and excited uterine contractions, expelling large quantities of bloody fluid, and opaque, flattened, flesh-colored bodies, irregular in size and form, many of which looked like pieces of decidua, generally longer than they were wide, and measuring about three to ten or twelve inches in length; others consisted of tuberosities strung together by more or less elongated and constricted portions. Many of these measured from two to five inches in length. All of these bodies were covered with a thin membrane (exochorion), from which sprung numerous bud-like processes, varying from one to threce lines in length. No where did these growths present the vesicular
appearance which characterizes hydatidiform degeneration of the chorion villi, and when placed in a basin of water, they sunk to the bottom like pieces of flesh.
The quantity of these bodies discharged would more than fill a quart measure."
We venture the presumption as a safe one, that these lines will scarcely attract the eye of any practitioner of any experience who has not encountered his similar case, and will not at once recognize it under its new title as a simple case of mole, and of the variety spoken of in the older obstetrical works as the mola carnosa. The history of the case, the symptoms, the character of the discharge, and above all, the microscopical results decide it as definitely as any collection of facts can.
“On microscopic examination of these bodies (which had been in alcohol for nearly twelve months), they were found to consist, essentially, of mucous tissue, or more literally, cells with here and there an indistinct fibrous appearance. Fatty metamorphosis had commenced in the tissue. The largest tuberosities contained masses of blood corpuscles and granular debris. No blood vessels were found, although searched for diligently.”
What is a mole? So long ago as the time of Dubois and Velpeau, who wrote during the formation of the modern school of pathology, a mole was regarded as an “hypertrophy of the villosities of the chorion.” (Chaily Obst., p. 82.) And although opinions have varied as to the primitive point of departure, i. e. whether in the decidua or the chorion, almost all agree that this hypertrophy constitutes the mole. (Vide resumé on the vesicular or cystic mole in its scientific and practical considerations, by Dr. Marcus Bloch, Freiburg, 1869. Schmidts Jahrbücher, August, 1869). Moles, organized fleshy masses. (Montgomery on the Signs, &c., of Pregnancy, p. 213). Moles, massa carnea (Vogel). Voigtel in describing the different species of mole, “in others," he observes, " the fætus itself is destroyed, and only its membranes and the placenta continue to grow for a time and get thickened and fleshy.” For a good description of the mola carnosa, see Lange's Geburtshülfe, p. 411.
“When a placenta has been formed, many alterations may occur in its tissue in consequence of hypertrophy, inflammation or other morbid changes, &c. When thrown off, these diseased placenta present usually the appearance of a fleshy mass, being much thicker and more solid than the natural tissue, &c., and in some, there is a fatty degeneration.” (Hodge, p. 460.)
Indeed, we scarcely entertain a doubt but that the gentleman himself entertains the opinion that the "remarkable condition" was a
mole attended with all the symptoms occurring, in the rule, as in this case. But we can not understand why the matter was regarded of such importance with all the literature we possess on the subject as to merit a re-print from the transactions.
Myxoma is a beautiful name and in accord with Virchow's anatomical classification of morbid growths. It means simply a tumor of mucous tissue, and was used before Virchow in describing this very condition, by Hildebrandt. In the resumé quoted above, occurs the following scntence: “Of particular interest is the occurrence of partial degeneration of the coty ledons, which have been observed both in the chorion and very often in the placentas of ripe fruits. (Hildebrandt, Myxoma fibros, plac.,) when the fætus is generally found dead, badly or defectively developed."
“Myxoma occurs oftener as hyperplastic, more seldom as heteroplastic formations. To the first belongs especially the myxoma of the placenta (the so-called grape or vesicular mole), which consists in an hypertrophy of the mucous basis of the chorin villi generally in the entire circumference of the membranes.” (Allgemein :' Pathologie, Uhle & Wagner, p. 400).
“Strapman found the decidua of a three months ovum thickened in places to three to four lines," and besides this general thickening, several perfectly smooth, somewhat flattened polypous excrescences, with broad bases. Besides these mucous masses were observed, likewise, other small polypi with pedicles, in commencement.
Virchow describes a similar case from a supposed syphilitic disease of the membranes, wherein the large mucous masses possess a smooth surface of a reddish color. He considers it a hyperplasia of the decidua (Klob. p.557-8.) He, Virchow, believes also that the enlargement of the villi occurs outside of the cells, which may either persist or perish by fatty degeneration. The tissue is, besides, identical with that of the umbilical cord.
“It is among the tumors due to a proliferation of the mucous tissue that is among the myxomata that hydatidiform degenerations also are now ranged, and they are called myxoma of the villi of the chorion.” (Charpentier sur des Malad. du Placenta et des Membranes, p. 137).
“The mucous tissue exists also in a high degreee in the tissue of the umbilical cord, which is called the gelatine of Wharton.” (Charpentier, loc. cit.)
The most interesting case of mole, we may mention in passing, which we have ever encountered, is recorded in Klob's Path. Anat. of the Female Sexual Organs, p. 529, wherein an extra uterine pregnancy degenerated to a mole, while a mole also existed in utero, which proved fatal by bæmorrhage in the second month.
The case reported then, is simply a case of molar pregnancy with the usual termination, and occurring at the time (three months) when it is most likely to occur, because of the increased vascularity at the period of the placental formation, and from the fact that vearly twelve months elapsed between the accident and the report, the whole case bears the impress to us of a resurrection from its spiritual preservation and a re-imbodiment under the newer and more fashionable name.
The "most remarkable condition” is that of the accompanying plate, which consists of a number of irregular lines enclosing an open cavity, and which does not convey nearly as good an idea of the condition described as if the book had been suddenly closed on three or tour unfortunate insects between.
J. T. W.
REPORTS ON THE DISEASES OF CATTLE IN THE UNITED
STATES, MADE TO THE COMMISSIONER OF AGRICULTURE, WITH ACCOMPANYING DOCUMENTS.
Washington : 1869. Pp. 190—8 ro.
The remarkable increase of disease among the domestic animals of the United States, in the last fifteen years, has attracted general attention, and the fact is of deeper interest because this prevalence of destructive plagues among these creatures has been attended by a signal exemption of the human family from all epidemic disorders. Except cholera, which spread over the continent in 1866, we have had no generally diffused disease since the fatal malady, called by the people cholera for want of a name more descriptive of its character, appeared about fifteen years ago among our hogs and the various families of poultry. What connection there is, if any, between these facts it would be unprofitable, in the present state of our knowledge, to inquire. But it can not be regarded as uninteresting that, at the time when man is enjoying the highest health, the animals associated with him are suffering from destructive diseases. It establishes at least this fact, that the causes of disease are not common to him and the lower animals. The “vengeful arrows" which destroy his “dogs and mules,” are not those which fasten upon him, and the infection by which he is poisoned passes harmlessly over them.