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THE CANADA LANCET,

A MONTHLY JOURNAL OF

MEDICAL AND SURGICAL SCIENCE.

VOL. XII. TORONTO, AUG. IST, 1880.

Original Communications.

to admit my finger as far as the os internum; the cervix was about 11⁄2 inches in length; from this date until the 30th dilatation went on gradually, when I was able to pass two fingers into the uterus. I found it empty and about 21⁄2 inches in depth; slight hæmorrhage had been going on steadily all the week from the uterus. Rigors commenced on No. 12. the evening of the 28th and continued until the following morning, followed by fever and perspiration. On the 30th, Dr. Lindsay, of Strathroy, was called in consultation. During the night vomiting and diarrhoea set in, which much reduced her, and not being able to take much nourishment she sank and died on the 6th of June. The position of the child could be readily made out from external examination of the abdomen before death.

VENTRAL EXTRA-UTERINE PREG- ·
NANCY.

BY ABRAHAM FRANCIS, M.R.C.S.ENG., DELAWARE, O. Mrs. P., æt. 25; bilious temperament; married seven years; had two miscarriages before October, 1876, when she was delivered of a healthy child, natural labor; had one miscarriage since; subject to dyspepsia and leucorrhoea, otherwise healthy.

Autopsy, twenty-four hours after death.-The peritoneum was very dark colored; omentum easily broken down upon pressure; abdomen contained a quantity of dark grumous fluid; adhesions in Out. 12, 1879. She had an attack of peritonitis many parts-all the appearances of inflammation and colicky pains, but by the employment of anti- of long standing. The placenta lay across the pelphlogistic remedies, principally fomentations and vis just above the brim, having upon its under anodynes, she got better in a few days. Catamenia surface the bladder and uterus, and upon its upper regular to the present. About this time the abdo- the foetus. The right edge was firmly attached to men commenced to enlarge in the right inguinal | the fimbria of the Fallopian tube and broad ligaregion From this time she had good health, ex-ments of the right side for about 21⁄2 inches. This cepting slight pains occasionally, and did not have occasion to consult me again until April 9, 1880, when a return of pain of great violence took place, with tenderness of the abdomen and constipation. I bled from the arm, gave cathartics, chloral, morphia, and other remedies. In a few days the inflammatory symptoms subsided and the pain nearly left, but tenderness continued. From this period she gradually gained in strength and appetite, was able to be up and walk about the house, and her bowels assumed a healthy state. The death of the foetus took place about the 17th, which, according to Mrs. P.'s reckoning, was at the ninth month. She felt no movement of the foetus after this date; the secretion in the breasts disappeared; the abdomen diminished in size and the child fell to the lowest side as she turned in bed.

No particular change took place in her condition until May 24th, when pains came on like labor which continued regular, but not strong, for about twenty-four hours. They returned again on the 29th and continued for about twenty-four hours. On the 24th the os externum was sufficiently dilated

was the only attachment to the mother. It had a nodulated appearance, thick compared to its width, being 2 or 21⁄2 inches thick and 5 inches in diameter, weighed about 21⁄2 pounds, and was of a firmer texture than usual. The foetus lay diagonally across, the head to the left and rather the lowest, and back to the front of the mother. It was enveloped in a thin transparent membrane containing a nearly colorless fluid, through which the hair of the head, left ear, back and right hand could be seen as it lay in situ. It looked like a fœtus of nine months. The cuticle was separated only upon the abdomen and a few other parts; the bones of the head and face were quite loose. It was a well developed male, weighing about 7 pounds. The cord was about 2 feet long. The uterus was healthy and lay in the hollow of the sacrum; os dilated to the extent of about 2 inches; internal membrane rather congested.

The following are some of the points in the case worthy of particular attention:-1st. The regular return of the catamenia for the first three months. 2nd. The occurrence of inflammation in the early

stage of pregnancy and its continuance more or less throughout. 3rd. The abdomen commencing to enlarge in the right inguinal region. 4th. The readiness with which the foetus could be felt through the parieties of the abdomen, and its tendency to fall to the lowest side. 5th. The death of the foetus at the ninth month, the subsequent disappearance of the milk in the breasts, and diminution in the size of the abdomen from the same date. 6th. The state of os and cervix uteri in last stage of pregnancy, and the occurrence of hæmorrhage from the 24th of May to the 29th, much resembling the catamenia.

DOUBLE OVARIOTOMY AND AMPUTATION OF THE UTERUS.

cocoa-nut and regularly enlarged. The pedicle was large, being about 21⁄2 inches in diameter, connecting the fibroid outgrowth with the uterus, and very vascular, so that the clamp or suture might have been used equally well. After a great deal of trouble, owing to the very strong adhesions posteriorly, the tumor was drawn out, and the clamp applied, but as this held the parts awkwardly, it was transfixed and ligated in two portions, with strong silk, divided, and the peritoneal edges sutured with continuous sutures of fine silk.

On examining the ovaries it was found that both were fibroid in character, being enlarged and vascular; they were brought into view by raising the uterus. Unfortunately, in so doing, the posterior adhesions binding down the uterus were broken down and troublesome hæmorrhage set up. This was controlled for a time with sutures, but was

BY MR. J. KNOWSLEY THORNTON, M.B., C.M., ETC., found to have re-established itself so much that the

SAMARITAN FREE HOSPITAL.

(Reported for the CANADA LANCET by Allen M. Baines, M.B., L.R.C.P. Lond.).

Case.-S. W., æt. 38, an unmarried woman; occupation—a cook. Appearance fairly healthy; has to some extent the general coloring of face peculiar to those suffering from uterine complaints.

Inspection. The abdomen is occupied by a hard' round, mobile tumor, which can be moved freely from side to side, and rolls over when the patient shifts from side to side in bed. It is held below in the pelvis, and is evidently closely connected with the uterus. The os and cervix are outside the vulva, and irreducible. Immediately in front and behind the prolapsed portion, fibroid nodules can be felt, those behind pressing down the recto-uterine pouch to the verge of the anus. Menstruation regular. Urine scanty and painful in passing; at one time she had complete retention. The sound passed 21⁄2 inches in the normal direction.

Operation. The operation, as usual, was strictly antiseptic in detail-Mr. Merideth assistant-Mr. Doran anesthetist, the perchloride of methylene being used. A 4-inch incision in the median line exposed the tumor; there was no ascitic fluid in the abdominal cavity. On the passage of the hand into the cavity a large hard mass connected with, and being an outgrowth from the uterus was felt, at the anterior part and right side-the uterus being below, large and fibroid, about the size of a

actual cautery was necessary to check it. The base of the right ovary was now clamped, close to the uterus, transfixed, ligated and divided, a third ligature being used to ensure safety. The left ovary was then treated in the same way. In the tightening of the clamp the diminution in volume and frequency of the pulse was marked, showing that slight shock was experienced. Very serious hæmorrhage was now found to be going on from a split in the uterine tissue between the uterus and stump of the left ovary, caused by the clamp tearing this tissue, it having to be placed in close proximity to the body of the uterus owing to the very short pedicle. This was stopped, for a time, by sewing around the bleeding points, with a fine needle and silk, in the bag-mouth method. The sutures were now put in for the closing of the abdomen, Mr. Thornton not having intended to remove the uterus at all. However, it was found that oozing was still going on from this same part -the stump of the left ovary. The actual cautery was applied, hæmorrhage stopped, the uterus again replaced, and the stitches again put in, only however to find that the cautery had not done its work perfectly. Again the stitches were taken out and the cautery more thoroughly applied, but it was found to be totally unable to check the bleeding. Mr. Thornton now decided on amputating the uterus. A strong whipcord was placed around the middle of the uterus and tightened, over this the largest size clamp was applied and the uterus re

moved above it. In tightening the clamp around this very thick fleshy mass, the lowering in volume and rapidity of the pulse was very marked. There was some hæmorrhage just below the site of the clamp, this was however pretty thoroughly checked by the cautery. A good deal of sponging was done and but very little blood left in the abdominal cavity. The stump was transfixed outside the wound, and thoroughly tanned with perchloride of iron. No drainage tube was used. The bladder was emptied by the catheter, and the vagina thoroughly cleansed. Small pledgets of cotton gauze were stuffed in between the clamp and the wound, and the usual antiseptic dressings applied. The operation was commenced at 9.30 a.m., and finished at 12.15 p.m. The woman had lost a great deal of blood during the operation; her lips were blue, extremities cold and pupils widely dilated; pulse 68; temp. 98°8'. She never had a bad symptom after; her temperature did not go above 100 S'. The clamp was removed on the 16th day after the operation and she was discharged on the 46th day, looking and feeling very well.

ELECTRO-THERAPEUTIC APPARATUS.

BY A. M. ROSEBRUGH, M.D., SURGEON TO THE TORONTO EYE AND EAR DISPENSARY.

(Read before the Toronto Medical Society, June 17, 1880).

(Continued from page 330).

II. FARADIC BATTERIES.-When a wire is stretched between two telegraph poles, the wire being near to, without touching the telegraph wires, and the two ends brought down and attached to the two poles of a bell telephone, a click is heard in the telephone whenever the current in a contiguous telegraph wire is interrupted, and this click is heard both at the closing and at the opening of the telegraph circuit, the latter being indeed the louder of the two. This clicking is the result of induction, an induced current being generated by the interruptions of the galvanic current of the parallel telegraph wire. Whenever, therefore, two closed circuits are brought in close proximity, and an electrical current generated in one, an induced current is developed in the other. The one is called the primary and the other the secondary circuit, and the electrical current in the primary

circuit is called the primary current and the current in the secondary circuit is called the secondary or induced current. The secondary or induced current was discovered by Faraday, hence the secondary current apparatus is called the Faradic battery. In the Faradic battery there is a core of soft iron, around which are coiled two layers of thick insulated copper wire, forming the primary coil and which are connected with the wires of the battery cell and forming together the primary circuit. In this primary circuit is inserted an autcmatic circuit interrupter. The secondary coil consists of eight or ten layers of very fine silk-covered copper wire, coiled around the primary coil and the two ends attached to screw posts, forming the poles of the secondary circuit. Whenever the current in the primary coil is interrupted a secondary current is induced in the secondary coil, and this secondary is strengthened by the presence of the soft iron core. The secondary current has high tension. It will readily pass through many hundred miles of telegraph wire, through eight or ten persons when their hands are joined, or through a large wash-bowl of cold water.

There are two forms of the Faradic battery, the separate coil and the continuous coil machines. In the separate coil machine the primary and secondary coils are separate and independent. In the continuous coil machine the primary and secondary coils are connected. In the simplest form of the continuous coil machine there is a primary coil composed of short and thick wire (two layers of No. 18 cotton-covered wire), an outer coil composed of long and fine wire (eight or ten layers of No. 33 silk-covered wire), and an intermediate coil composed of medium-sized wire (two layers of No. 24 silk-covered wire), and which, by means of a switch, may be made to form part of the primary coil at pleasure. When the switch is so placed that the primary current passes through the short primary wire only, the induced current is strong, the resistance of the circuit being less than the internal resistance of the battery cell; but when turned so as to include the intermediate coil, the current is weak, the resistance of the circuit being greater than that of the battery cell. The induced current may be used from the intermediate coil alone, from the secondary coil alone, or from the two combined. The wire of the primary coil may also be included in the secondary circuit if desired.

In the better class of these Faradic batteries the secondary coil is subdivided into two or more coils, so as to be able to furnish a greater variety, both of quality and strength, of current. In the separate coil machines the primary coil is not in any way connected with the secondary coil, and it is not usually subdivided. The secondary may, or may not be. In the small Gaifé battery, which is a separate coil machine, neither the primary nor the secondary are subdivided.

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PL

Z

Ph

IC

B

Sw

TORONTO END CO.

FIG. 2.

C. POTTER

TORONTO.

Diagram of Potter's No. 1 separate coil Faradic machine. Z. Z.

Zine plates. Pl. Platinum plate of Smee's cell. P. N. Screw posts for primary wire. I. C. Induction coil. (In the drawing, these letters have, by mis: ake, been reversed). C. Soft iron core (movable). Rh. Vibrating rheotome. So. Switch for tapping induction coil. B. D. Poles of the induction coil. By

means of the switch the second

ary current from the whole or

a

part of the induction coil may be used at pleasure.

Methods of modifying the current.- -1. In the No. 1 Faradic battery the soft iron core is movable, and the strength of the current may be gradually diminished by withdrawing the core. In the No. 2 battery a soft iron sheath cov. ers the induction coil and diminishes the strength of the induced current by di verting the induction to itself. The strength of the current is increased by withdrawing the sheath, and diminished by replacing it. 2. The strength of the current is modified by the strength of the acid solution. When strong currents are required the acid should be added in the proportion of 1:12 instead of 1:20. 3. When large moist sponge electrodes are used, the strength of the current is modified by

the degree of pressure on one or both electrodes. 4. The strength of the current is also modified by being passed through the arms and body of the

operator.

Direction of the current.-When a pole changer is used, the direction of the current is changed by reversing the switch. It may also be changed by reversing the position of the electrodes on the body, or by reversing the connections of the wires at the A. B. C. D. posts. The positive pole is the least

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Diagram of continuous coil machine (No. 2 Faradic machine), Z Z. Pl. Zinc and platinum plates of Smee's cell. P. N. Poles of pri mary wire. Rh. Vibrating rheotome. Sw. Switch for tapping pricontinuous coil. Sh. Soft iron sheath for covering induction coil. A. B. C. D. E. Posts for tapping mary and intermediate coils.

To prepare the Faradic battery for use.-If a Grenet cell is used, the zinc plate is simply lowered into the acid solution and the battery is ready When Smee's (open) cell is used, the cell is filled nearly two-thirds full with the acid solution and the platinum plate is connected with the P. (positive) screw post and the zinc plate with the N. (negative) screw post. In using the battery for the first time, or in using a fresh solution, the acid mixture should be prepared an hour or two before it is required and should be quite cold. The solution for Smee's cell is composed of sulphuric acid one part and water twenty parts. The solution for the zinc carbon cell is composed of sulphuric acid one part, bichromate of potash one part and water ten parts. In the Smee's cell, a teaspoonful of quicksilver is put in the bottom of the cell, care being taken to keep it from coming in contact with the middle platinum plate. The zinc plates will be kept amalgamated by resting in the mercury. If the rheotome does not commence vibrating as soon as the battery is connected, the vibrator should be started with the point of the finger. It is sometimes necessary to re-adjust the screw which regulates the distance between the vibrator and the platinum point on the end of the screw.

FIG. 4.

Vibrating automatic rheotome. A. Clamping screw. B. Adjusting screw. C. Clamp for holding adjusting screw. D. Soft iron hammer attached to free end of vibrator. E. Soft iron screwhead attached to end of soft iron core of induction coil. F. Screw for attaching clamp. When the correct distance is obtained, the screw should be secured in position by tightening the clamping screw. The point of the screw should not press against the vibrator, but should touch it very lightly. It should be kept very nearly in the centre of the small platinum attached to the centre of the vibrator. The wire connections of the bat tery should all be screwed down firmly and care taken that no rust, dirt, or wire-covering be allowed to prevent good metallic connection, and this care is specially called for after the battery has been in use for several months or years. When the zinc plate is connected with N. and the platinum with P., the positive pole of the induction coils is at E. and the negative at A. After the battery has been in use for a few weeks the acid solution becomes weakened and saturated with sulphate of zinc; when this occurs it becomes necessary either to add more acid or make a fresh solution. When not in use, the zinc plates should be removed from the solution. In the zinc carbon cell the zinc is suspended by means of a jointed rod, which is simply elevated when the battery is not in use. When the Smee's (open) cell is used the acid, after use, should be removed from the box and thus prevent the metallic parts of the apparatus from becoming corroded from evaporation of the solution. It is well to have a separate cup or cell for holding the plates when removed from the solution, and the quicksilver may be kept in this extra cell instead of in the solution. When the zinc plates lose the amalgam, the surface becomes rough, local action is set up, and the current is weakened. Many plates are destroyed by using the

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acid solution too strong. There should be no escape of hydrogen gas, except when the circuit is closed.

Suggestions in using the Faradic current.-In applying the Faradic current to the head and other sensitive parts, the hand of the operator is the best electrode, the current passing through his body. The sponge electrodes should be large and well wetted, a bowl of warm water having been supplied for the purpose. We will suppose that we are

about to faradize the internal recti muscles for insufficiency. If it is a continuous coil machine that is to be used, the sheath (Sh.) is pushed in, and, at first, only a weak current used, viz., from the B. C. posts and with the switch (Sw.) turned to the weak intermediate coil post (Wk.). The battery having been put in operation, the patient is seated and takes the negative electrode in the hands, the connecting wire of which is attached to the B. post. The other electrode, which should be a wet sponge, rests on the table and is connected with the C. or positive post. The hands having been dipped in warm water, either the finger or thumb of one hand is pressed against the inner side of the eyeball, and after remaining in that position for a short time, for the purpose of reassuring the patient and preventing a shock, the other hand is extended to the sponge electrode on the table. The sponge should be pressed very gently and the pressure increased very gradually, while the effect of the current on the patient is carefully observed. If the current is well borne, its strength is gradually increased by gradually withdrawing the sheath. The sheath is replaced and the negative electrode is next connected with the D post, and so on. At the first sitting, I would not extend the séance beyond five minutes, and in this case I would alternate the application between the two eyes. One electrode is always placed in contact with the sensitive part before the secondary circuit is closed, and the circuit should always be closed gradually through a sponge or similar electrode. In general faradization and in other cases requiring strong currents, the switch is turned to the strong primary coil and the entire coil from A. to E. is used. These currents are, however, too strong to be passed through the arms of the operator.

III. ELECTRO-PHYSICS.-In works devoted to electro-therapeutics, there are certain elementary principles in electro-physics referred to, and a

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