Изображения страниц
PDF
EPUB

to the commencement of another; and that time, while other circumftances are equal, will always continue pretty nearly the fame; but if these should vary, the time will likewife vary in the fame proportion.

In women who are healthy the flux proceeds in an uniform course to the years of forty or forty-five; at which time the periods become gradually more irregular and protracted to the decline of life, which, in this temperate climate, is commonly eftimated at the age of fifty, when it generally altogether ceases, and along with it the capacity of having children. There are many instances, however, of the evacuation continuing fome years longer; and authors record hiftories of fome women who have had their menfes, and even proved mothers, at a much more advanced age. In general, it ceafes fooner in those who have had it early, than in others with whom it has begun later.'

He very juftly explodes the opinion of there being a noxious quality in the menftrual blood, and suggests the strongest prefumptive arguments for afcertaining the local origin of the flux.

The menftrual blood has been thought by many to be extremely different from the common mafs, and to poffefs many ftrange and even noxious qualities. Antient authors abound. with various whimsical relations to this purpofe; nor are fome of the moderns altogether free from fo ill grounded a prejudice. Milled by particular hypothefes, they have imagined, that the menftrual blood being of a venomous and corrupted nature, it was expelled from the body, in order to free the habit from its pernicious effects.

• These erroneous opinions feem to have originally fprung from Asia, and other hot countries, where the menftrual blood, being once extravafated within the cavity of the uterus, and detained for fome time among the folds of the vagina, muft neceffarily acquire an higher degree of acrimony than in more temperate climates. Wherefore, as a commerce with women in that fituation, was fometimes obferved to produce certain inconveniencies to the other fex, it was exprefly forbidden by the law of Mofes, under the feverest penalties; and certain days were allotted for purification, by means of proper ablutions, before the Ifraelitish women, either after their natural evacuations, or delivery, were permitted to renew the freedoms of the conjugal ftate: from whence, the fame falutary custom was early adopted by the neighbouring nations, and ftill continnes to be practifed all over the East. But the Jewish priests, mistaking the genuine fenfe of their legiflator, interpreted thefe neceffary precautions into an infinuation of fome inherent malignity in the uterine hæmorrhage, as the true caufe of fo'rigid an inftitution; and by degrees, fuperftition, to which they were naturally much addicted, fupplied a thousand chimeras to confirm their opinion. By this means, and the careleffness of fuc. ceeding times, which admitted this erroneous interpretation with too implicit a credulity, the menftrual blood came at length to be universally ftigmatifed as a poisonous recrement. Hippocrates, however, who followed no other guide but nature, affords not the smallest authority for this abfurd doctrine. On the contrary, he evidently entertained the highest idea of the perfect pu. rity of the menftrual blood, by comparing it with that which flows

from

from a victim. And, indeed, when we confider, among other things, the purpose for which it is apparently defigned in time of pregnancy, we cannot avoid concluding it to be of a foft, mild, and balfamic nature; otherwife, it would certainly make a very improper nourishment for the fœtus.

Great controversies have arisen among authors, concerning the local origin of the monthly discharge; fome contending that it proceeds from the vagina as well as the uterus, while others afcribe it to the former only. This fingularity of opinion feems to have been occafioned by an appearance of the menfes in fome women during the first months of pregnancy. The fact cannot be contradicted; but yet it needs not appear very surprising. The foetus, at this time, is too fmall to confime the whole quantity of blood that used to pass by the futerus; in confequence of which, efpecially if the woman be naturally of a plethoric habit, a redundancy will enfue. The fuperfluous portion must be difcharged by fome outlet or other; and therefore, as it cannot find a way through its ordinary channel, whofe veffels are now fealed up by the adhefion of the placenta, it is highly probable, from the contiguous fituation of the vagina, that the opening will be made at this part. Such a circumftance, however, being the confequence of a violent effort only, and happening but in a few rare and uncommon inftances, can never be fuccefsfully urged, to invalidate thofe conclufions which have been repeatedly deduced from the more steady and ordinary courfe of nature. Befides obfervations made on fubjects who have died with the discharge upon them, a variety of other confiderations renders it much more probable, that the mentrual flux, in a natural state, proceeds from the uterus, and not from the vagina. The texture of the uterus is thick, foft, and vafcular, and confequently, better adapted to a fecretory office, than the thin, firm, and membranous fubftance of the vagina. The uterus, befides, from the first moment of conception to the hour of birth, being the natural habitation of the fœtus, whose nourishment appears, by the most irrefragible evidence, to depend upon the menftrual blood alone, it is more analogous to the wife conduct of nature in all her other operations, that the evacuation fhould be made at that part, where only it can be subservient to its original intention.'

Among the variety of practical improvements which are here fuggefted, Dr. Manning recommends the use of a pair of flannel drawers, impregnated every morning with the vapours of myrrh, maftic, and olibanum, as of great advantage in the fluor albus, and particularly efficacious in removing the pain in the fmall of the back, where that symptom was troublefome. He has also given a case of the successful exhibition of calomel in the infancy of that disorder, which determines the circumftances where fuch a remedy may be proper.

• When the disease is in its infancy, without any ulcers in the uterus, and there is no room to fufpect that it had been owing to any venereal infection, it seems more eligible to refrain from the ufe of calomel, as what, by its weight and fubtility, might farther injure the uterine veffels, which are already too much relaxed, However, if the matter be sharp and fœtid, and the disease of long standing, fo that there is reafon to apprehend lefs pernicious confequences

fequences from penetrating the fmall ducts, which are then become fo patalous, than by fuffering the disease to be supported by obftructions, which may exist in the veffels of the uterus, it is certainly expedient to try the effects of that remedy; and in such cir cumítances I have found it of great advantage. Nay, I have fometimes been induced to adminifter mercury at an early period, where the vascular system seemed to be much obstructed with viscid fluids, of which the following cafe is an instance.

A young woman, of a lax and phlegmatic habit of body, and about twenty-three years of age, had her menfes entirely fuppreffed for near four months. In a few weeks after the beginning of ber complaint, the felt an indolent tumour in one of her breasts, and, much about the fame time, was fenfible of being seized with the Auor albus. The matter was white and of a good confiftence, but the quantity pretty confiderable. She was ordered five grains of calomel, to be taken at night with conferve of roses, and purged off next morning with rhubarb; both which were repeated at fhort intervals for four times. The running fenfibly diminished after the fecond dofe. An emollient and diffolving embrocation was daily applied to the tumour, which alfo vifibly declined. An infufion of bitters, and chalybeate medicines in wine, was afterwards prescribed; by the ufe of which, in about a month after the commencement of the cure, her menfes returned, and he was entirely relieved from all her complaints.'

In the chapter on the Hyfteric Paffion, our author appears to have greatly availed himself of the judicious obfervations of Dr. White, whofe opinion he has adopted concerning the occafional caufes of that disorder. We fhall extract the paffage on the expediency of bleeding in the paroxyfm, as being a fubject much disputed.

In treating of the cure of the hyfteric paffion, as being a periodical disease, it is neceffary to confider the subject in two distinct views, namely, that of the paroxyfms, and that of the intervals betwixt them, or the temporary and radical cure. Phyficians have univerfally agreed in the proper method of attaining the latter, but their opinions, in refpect to the former, have been different and even totally oppofite to each other. The principal object of difpute is the expediency of bleeding, when the paroxifm is violent. It is urged in condemnation of that practice, that, as the : remote causes which produce the hysteric difeafe, are fuch as weaken the conftitution, an evacuation, which tends manifeftly to increase that debility, ought never to be admitted upon the principles of rational indication: for that it would be highly abfurd to expect even any temporary advantage from fuch a method of cure, as, if confidered in a prophylactic relation to the disease, we must allow to be extremely deleterious. In anfwer to this argument, it is infifted upon by the advocates for phlebotomy, that though bleeding, in certain circumftances, has a natural tendency to diminish the ftrength of the constitution, yet in general, fuch an effect of that evacuation is not uniform, but relative; and that in a violent paroxifm of the hysteric paffion, when the circulation of the blood is either much obftructed, or tumultuoufly agitated, by fpafms and convulfions, it is infinitely preferable to adopt an expedient which may obviate fuch imminent danger, rather than, from the appre

henfion

The ingenious tranflator of thefe Memoirs is fo well known to the public by the Letters of Lady Catefby, the Histories of Julia Mandeville, Emily Montague, &c. that it would be fuperfluous, on this occafion, to fay any thing of her literary abilities it will therefore be fufficient to obferve in general, that, in this tranflation, she has preferved the cafe, the vivacity, and the spirit of the original.

IV. Cafes in Surgery, with Remarks. Part the Firft. By Charles White, F. R. S. One of the Corporation of Surgeons in London, and Surgeon to the Manchester Infirmary. To which is added an Efay on the Ligature of Arteries. By J. Aikin, Surgeon. 4s. 6d. Johnston.

AS experiment and obfervation are unquestionably the great

means of improvement in phyfical and chirurgical knowledge, nothing is more obvious than the advantage which must accrue to thofe arts from a faithful relation of facts, when they have been fully afcertained by men of judgment and accuracy in their profeflion. In confequence, therefore, of a juft application of this remark, we cannot fail to admit, without referve, the merit of the production before us.

Among many valuable new cafes, this volume contains a few which have been formerly published in other works, and which, as we have already given a more particular account of them, we fhall now only mention in their order. It is our opinion, however, that they are here republished with great propriety, fince by this means the author's detached obfervations are drawn into one general collection.

The first article in this volume is an account of a new method of amputating the leg a little above the ancle joint. The author informs us, that in diforders of the ancle which required amputation, he has often, with regret, robbed the patient of a great deal of the found part of the limb, by cọnforming to the cuftom of amputating in the ufual place a little below the knee, till he was convinced of the utility of a different method of practice, by obferving the activity of a woman on whom, at the defire of her brother, who was a carpenter, and made her a wooden leg, the operation was performed a little above the ancle. By this means, the enjoyed the free use of her knee-joint in flection and extenfion. Mr. White at firft amputated by the double incifion, but afterwards adopted the method of the flap-operation, as it is improved by Mr. O'Halloran, unless the flap could not be made large enough, from particular circumftances.

The fecond is an extraordinary cafe of an accumulation of fæces in the intestines. A girl about fifteen years of age had been received into the Manchester Infirmary for a fwelling of her abdomen, with which she had been afflicted above three months. The diforder had greatly the appearance of an afcites, and tapping had been proposed. But no fluctuation being perceived, and fome other circumftances alfo contraindicating the defign, the operation was judged unadvifable. It appeared on a more particular inquiry, that for feveral fucceffive fummers, about the month of Auguft, fhe had been feized with great coftiveness, and tumefaction of the belly, which continued till the approach of the cold weather; when fhe had copious difcharges of ftool, which entirely relieved her till the fame time of the year returned. Her complaint, however, had, this feafon, protracted its ordinary term; for fhe was a patient in the hospital towards the end of November, from whence being discharged at her own requeft, fhe died in three days after. On opening the abdomen, there was found no great quantity of air, or water, but an accumulation of fæces which had diftended all the intestines, and particularly the colon to nearly the thicknefs of a man's thigh. Had purgatives been early enough administered, before the tone of the inteftines had been entirely deftroyed by the long diftention, this girl, in all probability, had recovered of her diforder; and indeed we cannot help being fomewhat furprized, that the fymptoms and hiftory of the disease. did not fuggeft fuch an indication to the gentlemen of the Manchefter Infirmary. Her diforder, however, was certainly too far advanced before he came under their care.

We are afterwards prefented with feveral cafes of plumb and cherry-ftones retained in the inteftines, which gave rise to very grievous complaints. Inftances of this kind occur in many medical authors, and it is to be wished that the danger was properly attended to. We heartily concur, therefore, with Mr. White in cautioning against it. My intention, fays he, in publishing these is not only to inform young practitioners, but to warn mankind in general of the great danger which attends the swallowing of the stones of fruit; and I doubt not but many have loft their lives from this cause, when the diforder has not been known, but mistaken for the cholic. Parents would do well to warn their children of the danger they incur by this practice; and I cannot help mentioning a ridiculous notion among the common people, that fwallowing the ftones helps the fruit to digest.'

The two fubfequent articles are on large tumours of the fcrotum, cured by operations, and one of which was accom

[blocks in formation]
« ПредыдущаяПродолжить »