Reviews and Notices of Books

1874 The Lancet  
768 paper was its extreme brevity. It scarcely afforded scop for discussion, as the conditions necessitating treatmen were not given. There were two points worth noting: first his preference for the vectis over the forceps; and, secondly there were two deaths from haemorrhage. This oughl never to happen if local treatment were regarded as thE necessary complement to other remedies, and used at thE proper time. The vectis was a lever and must remain so, it cannot be, strictly speaking, a
more » ... we may get thE head down by pressing against the pubis. However i1 could be substituted for the long forceps he could n01 understand, unless the handles were pushed into the vagina. When the head was in the pelvis anything would do to effect delivery, uterine action being set up by the irritation or interference; and the head being expelled, no tractile force was required, mere dislodgment of the head from an improper position being all that was requisite, and labour goes on at once. The vectis may do as well as the forceps in some cases where there is a want of adaptation of the head to the pelvis, but the vectis can accomplish less than the forceps, the latter being far better in most cases. Dr. SAVAGE would have been glad to have heard more about the treatment of convulsions, but nothing was said in the paper. The results seemed unusually satisfactory. It was a pity the treatment was not given. Dr. EDIS thought that in the cases given the vectis had been resorted to where ordinarily forceps would have been applied by most practitioners; and, indeed, the sooner forceps came to be considered as aids to labour, supplementing defective uterine expulsion by traction, in place of their application being looked upon as a formidable operation to be avoided as long as possible, the better for everyone concerned. Dr. HATES thought that the vectis lacks compressing force; it can only change the direction of the head. It was a question whether craniotomy had not been performed where a timely application of the forceps might have obviated the necessity. Statistics without details were practically useless. Regarding pregnancy as nature's highest physiological work, and one that ought to go on without trespassing on the domain of pathology, he had been led to observe that those who had severe floodings during labour were uniformly out of health, weak, dyspeptic, nervous, listless, and evincing an aversion to animal food. The tone of the muscular system was impaired, and the blood in a watery condition, leading to irregular or feeble contraction of the uterus, and haemorrhage as a consequence. Iron in these cases had proved, in his experience, of great service in preventing post-partum bsemorrhage, combined with potash where the urine was defective, or with soda if the liver seemed to be sluggish and the skin sallow, or with hydrochloric acid if the digestion was weak. Dr. BARNES asked if any of the Fellows had ever seen any reason to suppose that premature labour had been caused by the administration of iron P He thought we had not sufficiently ascertained the changes and diminution of vital force induced by pregnancy. A series of changes of a most important kind occurred, and if we only understood these we might preserve our patients from the consequences. As a rule, pregnant women did not place themselves under treatment. He alluded to an instance where a pupil of his had given iron to a pregnant woman, and was in consequence accused of intending to produce abortion. Dr. Barnes himself had given it in dozens of cases, and had never witnessed any ill consequences or instances in which abortion fnutd hP traced to its administration. He thought iron might safely be given where anaemia was present during pregnancy to improve the patient's condition, and lessen the risk of haemorrhage during parturition. Dr. SA1301A, of Rio Janeiro, read a paper on a New Method of Operating for Conical Cervix and Contracted Os Uteri. A silver suture was passed completely through the cervix. The wire was drawn out by means of forceps from the os uteri, divided, and the ends tied on either side and allowed to work their way out, the wire being twisted and so tightened every eight days. They remained in one month, when the remaining tissues were divided by means of a bistoury. Dr. TILT thought that division would have been better in the ordinary way, the risk being less and the advantage greater. Dr. EDis concurred with the President that it was hardly worth while making such a tedious operation, extending over a month, when it might have been done equally well and more satisfactorily in a few minutes by a slight incision.
doi:10.1016/s0140-6736(02)45575-4 fatcat:wkh4lj6vr5gdbmyhzo64jsnzji