These fits were preceded by a fracture of the os frontis, with depression, from which he readily recovered; but soon after he was attacked with convulsions. He now suffers pain on the injured side extending down the neck and left arm—the eye of the same side is diminished—the sight much impaired, and his memory almost entirely destroyed. A cicatrix covering a slight depression was easily found, above the left superciliary ridge of the frontal bone, and over the superior orbitar foramen. Under these circumstances, the operation of trephining was performed on the 7th of July, 1825, but with some difficulty, from the irregular thickness of the bone, and from the saw having to pass through the upper part of the frontal sinus. "The dura mater was unfortunately cut through for one-half the circumference of the circle." The parts were found more vascular than usual, and the under surface had a ridge corresponding to the internal depression, but too slight to have caused compression of the brain. "Having made a section of the frontal sinus, [with a trephine?] a part of the posterior table was removed with the circular piece. This portion of the internal table had been fractured, and separated to some distance from its inferior attachments to the frontal plate, and driven back upon the substance of the brain. Its sharp edge was worn round and smooth." This seemed to have been the cause of all the mischief.
After the operation, the patient suffered from pain in his head, with some moderate excitement, which was relieved by cathartics. He had no return of fits until the 25th day, when the wound was entirely healed. These had been brought on by overloading his stomach with food, and were followed by high arterial excitement and inflammation of the brain.
He was relieved in a few days by active depletion, and was discharged cured on the 20th of August. Nine months afterwards, this man continued free from fits, his memory had nearly recovered its usual strength, and he could attend to his business without any inconvenience.
VI. MIDWIFERY.
59. Gastrotomy.—M. Bulk, in Germany, has successfully performed this operation on a female, aged 36 years, of good constitution, under the following circumstances. The patient, during her pregnancy, suffered from a severe pain at the left and inferior portion of the abdomen; her menses were not suppressed, and every six or eight days, a clot of blood and mucus came from the vagina. Her general health was very good.
About the middle of her 8th month, she was washing some linen, and suddenly felt as if something was tearing in her abdomen; at the same time, a swelling of the size of two fists (poings) formed on the right side, below the umbilicus. She fainted, and for six weeks suffered dull pains in the abdomen. At this time, she had true labour pains for 48 hours, and was attended by a midwife. The os uteri dilated so as to admit one finger only. The tumour disappeared during these pains. The patient recovered, with the size of the abdomen undiminished.
In this state she continued for two years and three months, menstruating regularly. She became again pregnant, with little inconvenience until the 7th month, when her abdomen was painfully distended, and of a bluish colour, and fluctuation was induced on the least motion. At the full period, she was delivered of a large fœtus, which she suckled for 15 days. The infant then died of an aphthous affection.
Her milk ceasing, she rapidly declined with hectic symptoms. The tumour reappeared below the umbilicus about the size of an egg, and soon opened, discharging from small orifices a little pus. The opening was enlarged, and some skin and hairs were removed. The patient's constitution was fast yielding, and gastrotomy was immediately performed. An incision was made, with the requisite precautions, through the linea alba into the cavity of the abdomen, from two and a half inches above the umbilicus to within nine lines of the pubis, care being taken to prevent the escape of the intestines. A fœtus of full size, in which putrefaction had commenced, was found on the right side of the uterus. "I raised," says the operator, "the body with much care, and endeavoured to trace the umbilical cord. This was turned over the fundus of the uterus to the left side, and terminated in a vascular substance in a state of suppuration, (probably, the remains of the placenta,) which was situated below the great omentum. I pressed out, and dried up the pus, which covered these parts, by means of a sponge. The uterus was an inch and a half in length and an inch in breadth, of a pale rose colour, and could easily be distended (se laissait distendre aisément.) It was otherwise in a good condition."
The wound in the abdomen was closed with sutures. The patient was in great danger from inflammatory symptoms for 8 days, but eventually recovered. She left her bed on the 55th day.
60. Cæsarian operation, performed with safety to the Mother and Fœtus.—We condense from Johnson's Review for April last, the following summary of a case of Cæsarian section performed by Graefe, on the 20th of September, 1825.