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one from another. This, so far as the oid and well known species are concerned, may be true, but it does not necessarily follow that the new species added to our indigenous flora possess exactly the same properties, and the point whether they do or not is a desideratum, and should be determined by all our observing physicians, from the fact that nearly all of them are known to possess active properties. Some may be so qualified by other constituent principles in a state of nature as to obviate the objections so long brought against them for their occasional severity and uncertainty.

Our country, east, west, north and south, is well represented by this family, and their prevalence in the dry regions of the west rather goes to invalidate the observation of the generally very accu-. rate LINDLEY, that they can and often do affect a dry climate, as well as the cold and damp, as shown by the great number lately discovered on the great western plains.

TUBAL PREGNANCY-DEATH FROM HEMORRHAGE.

BY EDWARD W. JENKS, M. D., PHYSICIAN TO HARPER HOSPITAL.

MRS. R, Æt, 32, retired for the night, February 16th, in her usual health. Within an hour after was awakened by a severe pain in the hypogastric region, shortly succeeded by rigors and vomiting, which continued until the following morning, when I saw her. I was at once struck with her pinched expression and extreme pallor, so suggestive of hemorrhage, that I asked if she had any "flowing," or had had an abortion, but learned she had not. She complained of a constant desire to urinate, but her efforts were fruitless. I found the abdominal walls very much distended, dull on percussion, and exceedingly tender upon pressure, with the extremities drawn up as in peritonitis. I passed a catheter and found the bladder contained less than three ounces of urine; upon examining the uterus, I found the os patulous with no external sign of hemorrhage-the entire organ apparently much enlarged, yet the boundaries of enlargement not easily defined, as the superior walls of the vagina felt hard and inelastic; the least pressure upon any part of the uterus or superior vaginal walls caused severe pain. The os uteri was near

the vaginal outlet, and the uterus appeared wedged in or pressed down from above by some unusual cause. As the patient, to all appearances, was moribund, I did not consider further investigation, for the purpose of diagnosis, justifiable; I simply treated symptoms, prescribing whisky and ammonia, opium, and for the purpose of checking vomiting, combining calomel with the opium. I visited ber again in the afternoon, found the vomiting somewhat checked, yet the other symptoms aggravated, and the patient evidently succumbing. She died during the night, suffering extreme pain to the end, although having taken at short intervals full doses of opium from the time of my seeing her. Autopsy was made twelve hours after death, at which Dr. NOYES, Dr. McGRAW, and myself were present. The cavity of the abdomen was filled with venous blood, principally in a coagulated condition, in quantity, estimated by those present, as equivalent to one gallon. The viscera of the abdomen were found in a healthy condition. The blood was found to have been poured out into the peritoneal cavity through an opening in the right fallopian tube.

Hemorrhage within the fallopian tubes may occur during the menstrual period, if the congestion is extreme. SCANZONI mentions three cases of autopsies made of women dying during menstruation, where coagulated blood was found in the fallopian tubes, and one case of a girl who died with all the symptoms of acute peritonitis, where the only possible cause of death to be found was hemorrhage in the left tube, which was much distended, containing about two fluid ounces of coagulated blood, and communicated by the abdominal orifice or fimbriated extremity (not by rupture) with a sanguinous effusion of about sixteen ounces, almost all coagulated, which was situated in the cavity of the pelvis. ROKITANSKY mentions having met but four cases of hemorrhage of the fallopian tubes, except in tubal pregnancy, and mentions no cases of rupture, only where such pregnancy had existed. BARLOW met one case of hemorrhage in connection with abortion. Sir BENJ. BRODIE observed one case caused by retention of menses where there was occlusion. Rupture of the fallopian tube may occur from over distension by the menstrual fluid, by effusion of semen or pus, and ulceration through the walls of the tube. But the most frequent cause, without ques

tion, is tubal pregnancy. CHURCHILL says, there is one case on record where rupture occurred independent of the above mentioned causes, occasioned by a violent effort, followed by effusion into the abdomen and death.

When there is atresia of the uterus or vagina, the catamenia are retained, and by degrees, if it does not pass through the fallopian tubes into the abdomen, it may produce fatal rupture of one of the oviduct canals. In this case, from the fact of the complete degeneration of the ovary communicating with the ruptured tube, I did not

[graphic][subsumed][subsumed][subsumed]

A, Right half of uterus.

B, Placental tuft magnified fifty diam.

a, Probe passed from the fimbriated extremity of the fallopian tube out through the rupture, whence the hemorrhage originated. The white surface represents the placenta still retained in the cavity of the expanded oviduct.

b, Cyst in ovary laid open. The dark spots above show smaller cysts also laid open.

deem it possible that this could be a case of tubal pregnancy, in which I was sustained by the gentlemen I have named, but rather a case of fallopian hæmatocele, occasioned by retention of the menses, and that the enlarged vessels, in the region of the rupture, were owing to the previous existence of varicose veins, which communicated with the hæmatocele, and which increased by monthly supplies of blood, at last caused its thin covering to yield, death

ensued from rupture of the fallopian tube, having connection with the enlarged veins. This view was entertained, I think, by all the medical gentlemen who saw the specimen, and was especially borne out by an apparent clot within the ruptured sac, which was in part decolorized, as if it had been gradual in its formation. But the theory which seemed well sustained by many corroborative points of testimony, before the unerring scrutiny of the microscope, was proven to be a false one. Microscopic examination made by Dr. ANDREWS and myself proved the existence of unmistakable placental tufts upon the circumference of the supposed partially organized coagulum. Thus it seems that the ovary, which was deemed wholly degenerated, still retained enough of integrity to perform its normal function.

Your attention is also called to other points of interest in connection with this specimen, namely, the enlarged condition of the uterus, illustrative of chronic hyperemia, or so-called chronic metritis; the red points of follicular inflammation of the uterine canal, very plainly seen when first examined, and the glairy tenacious mucus with which the mouth of the uterus was filled, indicative of chronic inflammation of the lining mucous membrane; the cystic degeneration of the right ovary, and the beginning of cystic formations in the left ovary.

A CASE OF DISLOCATION OF FEMUR.

DR. G. W. TOPPING, of Dewitt, sends an interesting account to the Review of a case of "probable dislocation of the head of the femur into the great sciatic notch, and reduction by manipulation, before the diagnosis had been satisfactorily established." For want of space we are obliged to content ourselves with a brief synopsis of his interesting paper. A boy was brought into his office on January 30th, on account of a recent injury to the right lower extremity. He had fallen from a sleigh, had been caught fast by the right foot, and dragged for a considerable distance on the ground. A superficial examination revealed symptons of dislocation of the right femur, upward and backward. He was unable to stand on his right leg, or to move it forward or outward. Standing on his left foot, the right great toe rested on the left os calcis. The right heel was lifted slightly from the floor, and the corresponding thigh closely

hugged its neighbor. The boy, however, referring all his sufferings to a point below the knee, the doctor had him sit down, and in order to examine the leg more conveniently, took the foot of the injured limb on his knee. He thus flexed the thigh on the body at a right angle. Taking hold of the knee with one hand and the ankle with the other, he then rotated the limb outward. The patient complained but little during this process, and no sudden snap indicated the reduction of a dislocation, but, whatever the cause, all symptoms of injury, excepting a slight stiffness of the muscles, suddenly vanished, and the boy, who a few minutes before was not able to bear his weight on the limb, could now walk without difficulty. He recovered in a short time, without any untoward symptoms; no injury beyond a slight bruise was found to have happened below the knee. Dr. TOPPING is confident that the lesion was a dislocation of the head of the femur into the great sciatic notch, but not having made the diagnosis satisfactorily to himself previous to the rectification of the injury, he was too modest and honest to charge the price usual for the treatment of so serious a hurt.

Mc.

Selections.

[COPYRIGHT SECURED.]

Entered according to Act of Congress, in the year 1867, by E. FOUGERA, in the Clerk's office of the District Court, for the southern District of New York.

PHYSIOLOGICAL AND THERAPEUTICAL ACTION OF COD LIVER OIL.

"The minute division of the iodine in cod liver oil, the particular state in which it exists, must singularly facilitate its absorption by the tissues, and can in this way contribute more than the absolute proportion of this substance to the marked effects which this oil exerts on the animal economy.

"Also, iodine in the oil is not eliminated from the system, as the other soluble preparations of iodine; in this elementary combination its action is slower, more regular, and more persistent, as it is successively set at liberty in the economy, in proportion as cod liver oil is gradually decomposed in the blood."

BOUCHARDAT, Professor of Hygiene, at the Academy of Medicine, Paris. [Manuel de Matiere Medicale, pag. 749-1856.]

THE action of cod liver oil on the system is a double one; it is nourishing by its fatty elements, and curative by its medicinal bodies-iodine, bromine, and phosphorus, which it naturally contains; and to these three substances must be attributed its superiority over other fats or oils, either animal or vegetable, in the cure of

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