Reviews and Notices of Books

1906 The Lancet  
A few days later the removal of the primary disease could be i performed with scarcely any haemorrhage and as freely as t might be desired. CLINICAL SOCIETY OF MANCHESTER.-At a meeting of this society held on Nov. 20th Dr. John F. Le r Page, the President, delivered an address, in the course of a which he made a reference to Post-Partum Hmmorrhage and ( strongly denounced the teaching of the medical schools and of the text-books as antiquated, unscientific, and delusive. x His experience, he
more » ... s experience, he said, included about 5000 parturitions, in some of which death from post-partum haamorrbage appeared actually to have taken place, but he had never seen a t death. These cases were essentially of a nature which demanded instant action and there was absolutely no time for deliberation. He said that the whole teaching of the schools was to try various measures, such as kneading, cold water, hot water, ice put into the uterus, hot water injected into the uterus, iced water injected into the rectum, thrombosis by iron perchloride, and so on. If, before there was any hæmorrhage, the uterus did not contract, why should the obstetrician when the system was drained of vital fluid and the whole nervous system was paralysed, hope for such a miracle as that the impotent = uterus would in response to equally impotent castigations contract and retract itself into a firm and vital organ ? Dr. Le Page's recommendations for the treatment of post-partum haemorrhage were as follows. 1. In all cases of post-partum haemorrhage the abdominal aorta must be instantly compressed against the spinal column, by which means the current through the uterine arteries was at once shut off. A very important fact was that, although no blood was allowed 1 to pass the compressing hand, there was still a sufficient, 1 although very limited, supply through the ovarian arteries to maintain uterine vitality. Compression should be made by the ulnar portion of the left hand clenched, than which nothing could be more convenient and effective. At short intervals the pressure should be made to slide from one part to another of the available three or four inches of aorta so that no injury might be done to the sympathetic system of nerves, which formed a network around the vessel. The pressure should be continued until uterine contraction was secured, and the greatest care in its release, which should be gradual, was essential. 2. The pelvis must be elevated by means of a firm support under the loins. 3. The legs and arms must be raised to the perpendicular and bandaged. The effect of that manoeuvre was that in many cases almost a normal tension of the whole blood was attained in one or two minutes. 4. The right hand, previously sterilised, must be then passed into the uterus to detect any laceration or to remove any remaining portion of placenta and to afford a point d'appui for grasping and compressing the uterus from without. The bandages must be loosened very gradually and in proportion to the amount of liquid nutriment taken and the effect. MEDICO-LEGAL SOCIETY.-A meeting of this society was held on Nov. 20th, Mr. J. Troutbeck being in the chair.-After several exhibits of medico-legal interest had been shown, Dr. W. Wynn Westcott proceeded to narrate "Twelve Years' Experiences of a London Coroner" in a district the population of which exceeded half a million persons. His experience of medical witnesses was that a police surgeon of several years' standing was the best person to afford evidence in most criminal injuries; in cases of poisoning an analytical chemist was more useful than an expert pathologist. He had granted post-mortem examinations in nearly 70 per cent. of his inquests. Several causes had led to a decline in the number of inquests which he had held during recent years ; in all he had held 13,176 inquiries. The annual deaths from destitution varied from 12 to 18. Illegitimate children were curiously small in number when compared with better-class districts. The Infant Life Protection Act, 1897, the Midwives Act of 1902, and the Prevention of Cruelty to Children Act, 1904, were all forces for good. Simple natural deaths of adults were nearly all due to cerebral heamorrhage and syncope consequent on valvular or muscular heart disease. 68 per cent. of deaths from the rupture of aortic aneurysms were in males. Hoematemesis caused one death annually and hmmoptysis a score, 75 per cent. of the latter being in males. Deaths of old people after fracture of the neck of the femur were common, 70 per cent. of the victims being women who were usually over 80 years of age; the men were generally over 60 years. Every tenth case inquired into was a death of an infant while in bed: 709 were boys and 641 were girls. Of these 531 boys and 498 girls perished before they were three months old and 393 boys and 376 girls before they were two months old; 95 per cent. of the cases occurred in children under six months old ; the winter months showed the most numerous fatalities. He had had on an average one suicide a week: 465 males and 160 females ; no month was without a case. May and July were popular ; February and December were unpopular in this connexion. Dr. Wynn Westcott regretted that no means existed at present whereby the pathological discoveries made by post-mortem examiners could be recorded and preserved.-In the discussion which ensued the following took part :
doi:10.1016/s0140-6736(00)68739-1 fatcat:ow7bgilvkbeyvd2ync25z5u7uu