Viburnum Prunifolium in Abortion


Napier, A.D.

British Medical Journal 1(1315): 489-490

1886


Girl
Dressing
stump
Respiration
ceased.
l'ost
morten:
Extensive
thrombosis
of
venous
system.
Female,
d
Removal
of
After
90
minutes,
sat
up,
became
Humour
convulsed,
and
fell
back
uncon-
scious.
Breathing
went
on
20
minutes,
but
no
pulse.
No
post
mortem
examination.
Male,
40
Innominate
Urgent
dyspncea
on
lying
down,
aneurysm
I
and
stoppage
of
respiration
a
ft
er
a
few
inhalations.
Pulse
beat
for
10
minutes
after.
Post
nortem
:
Large
aneurysm
of
innominate.
Male,
24
Dislocation
of
Syncope.
Post
nuirtem.
:
Slight
dis-
humerus
ease
of
large
vessels.
Female,
55
Post
mortent,
—Enlargement
of
heart
and
liver,
and
disease
of
other
organs.
Male,
28
Paraphimosis
No
post
mortvnt
examination.
Male,
53
Cancer
oftongue
Syncope
at
end
of
operation.
Ligature
of
fe-
Syncope
at
end
of
operation
on
amoral
giving
a
little
additional
chloro-
form.
Post
morton
:
Heart
di-
seased;
aneurysm
or
mitral
valve.
Syncope.
Patient
greatly
emaci-
ated
;
lungs
congested.
Syncope
after
partial
recovery
of
consciousness.
No
post
in°
den
examination.
Removal
of
tit-
Became
cyanosed
early,
pulse
more
of
upper
stopped
just
as
operation
was
.
jaw
completeei.
lot
sio
rloin
:
Some
fibroid
degeneration
of
heart,
a
n
d
congestion
of
bases
of
lungs.
Male,
45
Female,
9
Inserting
drain-
age-tube
in
hip
Young
man
Male,
March
13,
18881
THE
BRITISH
MEDICAL
JOURNAL.
489
every
half-hour.
She
suffered
no
pain
at
all
'
was
quite
cheerful
and
sensible,
though
very
weak
;
was
not
sick
at
all
after
the
operation,
but
became
gradually
exhausted,
and
died
thirty
hours
after
the
opera-
tion.
There
was
no
sign
of
peritonitis.
I
was
not
permitted
to
make
a
post
mortem
examination.
It
may
be
objected
that
this
is,
in
cases
of
cancer,
at
best
merely
a
palliative
operation.
In
this
respect,
I
may say
t
hat
it
is
equally
valuable
with
gastrostomy
and
colotomy,
and
other
operations
for
the
relief
of
obstruction
from
the
same
cause
;
and
these
we
have
no
hesita-
tion
in
performing.
If
it
can
be
undertaken
earlier
in
the
disease,
I
believe
its
results
will
be
favourable.
I
also
think
that
it
ought
to
be
done
in
less
time
than
I
took
over
it
;
and
in
this
case,
I
should
not
consider
it
such
a
dangerous
operation.
Whether
the
jejunum
should
be
approximated
to
the
stomach
by
causing
it
to
form
a
hernia
through
the
great
omentum,
as
in
my
case,
or,
as
in
Mr.
Barker's
case,
by
causing
it
to
encircle
the
transverse
colon
(as,
from
his
description,
I
gather
it
did),
and
so
reach
the
anterior
surface
of
the
stomach,
I
am
unable
to
say.
I
think
that
this
operation
will,
in
future,
be
found
a
valuable
addi-
tion
to
surgery;
and
I
believe
that
Professor
Billroth
has
proposed
that
it
should
take
the
place
of
pylorectomy.
DEATHS
FROM
ANiESTHETICS
IN
1885.
By
ERNEST
H.
JACOB,
M.A.,
M.D.
Assistant-Physician
to
the
General
Infirmary,
Leeds.
THE
following
deaths
occurring
during
narcosis
by
various
anaesthetic
agents
have
been
recorded
during
the
past
year,
or
have
otherwise
come
to
my
knowledge.
With
the
view
of
estimating
the
number
of
administrations
covered
by
this
list,
I
am
glad
to
say
that,
through
the
courtesy
of
the
registrars
and
anaesthetists
of
St.
Bartholomew's,
St.
Thomas's,
and
the
London
Hospitals,
the
General
Infirmary
at
Leeds,
and
the
Royal
Infirmary,
Liverpool,
all
accidents
which
have
occurred
in
these
institutions
are
recorded,
so
that
I
include
no
small
proportion
of
the
surgical
centres
of
England.
Sex
and
I
Operation
for
Manner
of
Death
and
Post
Age.
Markin
Notes.
1.
Salford
Infir-
mary.
2.
Glasgow
Western
In-
firmary.
Northallerton
Hospital.
4.
Birmingham
Workhouse.
5.
Guy's
Hos-
pital.
1.
Middlesex
Hospital.
7.
Langley
Moor
S.
Newcastle
In-
firmary.
ti.
Glasgow
Royal
Infirmary.
10.
Charing
Cross
Hospital.
11.
Newcastle
12.
London
Hos-
pital.
pected
at
any
moment.
No.
12
again
was
a
serious
and
prolonged
operation,
though
there
was
not
much
h:ernorrhage.
The
list
of
deaths
occurring
during
the
administration
of
ether
includes
at
least
one
remarkable
case,
which
I
will
give
in
greater
detail.
CASE
i.
—This
occurred
in
the
London
Hospital.
The
patient,
a
man,
aged
62,
was
narcotised
in
order
to
reduce
a
dislocated
shoulder.
He
partially
recovered,
but
the
bag
(Ormsby's
inhaler)
was
again
put
on
his
face.
In
three
minutes
he
began
to
look
pale,
his
breathing
was
feeble
;
dusky
pallor
increased,
in
spite
of'
artificial
respiration.
At
the
post
mortem
examination,
the
lungs
were
emphysematous
and
congested,
and
there
was
bronchitis.
The
heart
was
flaccid
and
fatty,
with
adherent
pericardium.
CASE
IL—This
case
occurred
in
the
practice
of
the
Leeds
Dis-
pensary.
A
man,
aged
58,
suffering
from
empyema,
took
ether
in
order
to
have
the
pleura
incised.
For
about
seventeen
minutes
he
breatbed
well,
and
was
of
good
colour.
The
ether
was
then
discon-
tinued,
as
the
narcosis
was
sufficient,
and
no
more
was
given.
About
fifteen
minutes
afterwards,
the
pulse
and
breathing
began
to
fail.
He
seemed
to
die
in
a
sort
of
syncope.
No
post
mortem
examination
was
allowed.
CASE
girl,
aged
10,
much
emaciated,
and
looking
very
ill,
was
brought
to
a
surgeon
to
be
sounded
for
a
calculus.
When
she
had
taken
but
a
few
inhalations,
she
was
observed
to
be
very
pale,
the
pulse
ceased,
the
breathing
continued.
The
usual
remedies—
artificial
respiration,
galvanism,
injections
of
brandy,
etc.—were
tried
in
vain.
The
girl
appeared
to
be
suffering
from
tubercular
disease
of
the
kidney,
but
there
was
no
post
mortent
examination.
This
completes
the
list
of
casualties
under
ether,
a
very
satisfactorily
small
record,
considering
the
general
use
of
ether
in
our
large
surgical
centres.
The
first
case
is
one
of
a
large
number,
where
the
narcotisation
and
a
small
operation
form
the
"
last
straw
"
to
overweight
a
damaged
heart
amid
lungs.
No.
2
is
difficult
to
explain,
as
at
least
fifteen
minutes
had
elapsed
since
the
patient
had
had
any
ether,
which
he
had
apparently
taken
very
well.
He
was
weak
and
emaciated,
but
able
to
walk.
No.
3
is
the
most
remarkable
case
of
the
kind
I
have
ever
known.
The
patient
took
not
more
than
a
drachm
of
ether,
and
died
in
a
pre-
cisely
similar
manner
to
that
which
generally
obtains
in
the
case
of
chloroform.
The
only
case
I
can
recall
in
any
way
resembling
it
is
one
reported
some
years
ago,
where
a
woman,
about
to
have
her
breast
removed
for
mali
g
nant
disease,
took
three
or
four
inspirations
of
ether
from
a
frame-in
haler,
became
white
in
the
face,
and
died.
The
question
may
be
raised,
whether
this
was
not
really
a
death
in
which
fright
or
emo-
tion
played
the
principal
part.
It
is
difficult
to
conceive
that
a
drachm
of
ether
can
be,
under
any
circumstances,
a
fatal
poison.
There
have
been
no
deaths
recorded
from
the
so-called
methylene
bichloride,
or
from
mixtures
of
chloroform
and
ether,
during
the
past
year.
In
conclusion,
I
wish
to
say
a
word
on
the
question
of
pub-
lishing
deaths
of
this
kind.
A
gentleman
holding
the
office
of
anaesthetist
to
a
large
hospital,
to
whom
I
wrote
for
information,
ex-
pressed
to
me,
most
courteously
indeed,
his
conviction
that
to
publish
deaths
from
aniesthetics
was
a
most
pernicious
custom,"
tending
to
bring
trouble
on
young
practitioners,
in
whose
practice
these
acci-
dents
usually
occurred.
I
cannot
see
that
this
need
be,
if
no
names
or
localities
be
mentioned
in
the
report,
and
the
details
of
the
death
be
only
published.
Considering
we
are
still
in
search
of
a
perfect
anassthetic,
it
is
of'
great
consequence
that
all
details
of
fatal
cases
should
be
made
known;
and
I
should
be
glad
to
publish
in
my
yearly
list
such
cases
as
are
sent
to
me,
in
such
a
way
as
to
avoid
the
recog-
nition
of
the
ease
by
the
public
who
may
read
the
medical
journals.
VIBURNUM
PRUNIFOLIUM
IN
ABORTION.
By
A.
D.
LEITH
NAPIER,
M
D.,
Vice-President
of
the
Edinburgh
Obstetrical
Society
;
and
Examiner
in
Midwifery,
at
University
of
Aberdeen.
Locality.
Boy
Necrosis
of
leg
••••••••••••
The
above
list
shows
that
thedeaths
from
chloroform
occurred
during
an
unusually
severe
list
of
operations,
Nos.
2,
5,
7,
and
10
only
being
for
trivial
surgical
manipulations.
So
far
as
can
be
judged
from
the
published
accounts
(which
in
most
cases
are
very
meagre),
No.
3
seems
to
be
death
rather
from
the
exhaustion
of
a
prolonged
operation
than
from
the
direct
action
of
the
anesthetic,
while,
in
No.
4,
the
patient
was
in
so
dangerous
a
ca
-
aidition,
that
a
fatal
result
might
have
been
ex-
WITH
reference
to
Dr.
Maclie
Campbell's
communication
regarding
the
treatment
of
abortion,
in
the
JOURNAL
for
February
27th;
I
wish
to
corroborate
his
observations,
and,
at
the
same
time,
to
take
excep-
tion
to
certain
inferences
contained
in
his
paper.
I
have
prescribed
viburnum
prunifolium
for
fully
three
years.
I
fancy
I
was
among
the
first
to
use
it
hereabouts,
as,
when
prescribed,
it
could
not
be
obtained
without
considerable
delay
in
Edinburgh
Being
dissatisfied
with
the
results
of
other
preventitive
treatments
in
490
THE
BRITISH
AEDIC'AL
JOURNAL.
[March
13,
1886.
4._
some
cases,
anti
reading
Lusk's
recommendation
(Science
and
Art
of
lifidunfcry,
second
edition,
page
301),
in
which
he
refers
to
Jenk's
paper
in
the
Transactions
of
the
American.
6'
ynovological
Society,
I
gave
the
drug
a
trial,
and
have
since
used
it
repeatedly.
In
one
case
of
so-called
"
habitual
abortion
"
it
failed
to
do
good.
This
lady
had
one
healthy
child,
then
five
abortions,
or
premature
labours,
at
dif-
ferent
periods
;
then
a
child
born
living
at
five
months
and
a
half,
which
died.
She
was
then
treated
with
chlorate
of
potash
and
iodide
of
mercury,
with
iron
alternately,
and
was
delivered
at
six
months
and
fourteen
days
of
a
very
feeble
living
child,
now
a
line
healthy
boy,
6
years
old.
Next
time,
when
pregnant,
she
was
ordered
viburnum,
but
aborted
at
the
third
month.
She
was
again
pregnant,
was
treated
with
viburnum,
and
aborted
at
the
second
month.
Pos-
sibly
there
was
a
specific
element
in
this
case,
judging
from
the
one
successful
pregnancy
;
but
I
have
not
been
able
to
establish
it.
Another
patient
aborted
twice
after
marriage
;
when
pregnant
for
the
third
time,
she
was
treated
with
chlorate
of
potash,
and
delivered,
at
term,
of
a
healthy
child.
She
next
aborted
at
the
second
month,
in
spite
of
viburnum.
Abortion
was
again
threatened
about
four
months
ago,
but
passed
off
after
taking
viburnum
;
and
she
is
now
fully
six
months
pregnant.
A
third
case
had
recurrent
monthly
uterine
contractions
from
the
second
to
the
seventh
month.
Small
clots
and
quantities
of
blood
passed
several
times.
In
this
case,
bromides,
in
combination
with
nepenthe,
were
found
more
effectual
than
viburnum.
A
fourth
case
derived
benefit
from
viburnum,
but
markedly
so
when
given
in
combination
with
nepenthe
and
belladonna.
I
might
adduce
many
more
such
cases
in
the
same
strain.
On
the
whole,
my
impression
is
distinctly
in
favour
of
the
drug
;
yet
I
cannot
believe
it
to
be
in
every
case
"a
sure
arrester
of
uterine
action."
With
all
courtesy,
I
must
demur
to
the
method
in
which
Dr.
Camp-
bell's
cases
are
recorded.
Brevity
excuses
much,
but
accuracy
is
at
times
sacrificed
thereby.
In
the
first
place,
it
is
surely
necessary
to
show
that
abortion
was
actually
threatened
ere
we
write
of
its
arrest.
Do
uterine
contractions
never
occur
without
separation
of
the
decidua,
or
death
of
the
foetus
Do
not
very
many
women
suffer
severely
from
pains
at
each
monthly
period,
and,
in
many
cases,
carry
to
term
with-
out
any
drug
What
is
meant
by
the
os
dilating
?
Case
1,
in
which
abortion
occurred,
is
the
only
case,
except
2,
where
the
os
is
referred
to
;
in
Case
1,
"it
continued
to
dilate."
Now,
dilatation
of
the
os,
un-
less
it
be
the
internal
os
that
is
meant,
is
by
no
means
uncommon
with-
out
abortion
following.
Scanzoni
has
recorded
a
case,
now
classical,
in
which
not
only
was
ordinary
treatment
employed,
but
the
intro-
duction
of
a
sound
and
intra-uterine
injection
failed
to
bring
about
"
the
inevitable
abortion."
I
have
mentioned
cases
with
a
somewhat
similar
history.
(Transactions
of
the
Edinburgh,
(N,stetrical
Society,
vol.
ix,
p.
109.)
Nor
do
"
breaking
of
the
waters
"
or
hfentorrhages
invariable
end
in
abortion.
The
"
flow
of
the
waters
"
may
be
duo
to
very
active
glandular
secretions
from
the
cervix;
or
even
to
the
formation
of,
and
rupture
of
amnio-chorial
pouches,
the
"
false
bags
of
membranes."
We
often
meet
with
the
latter
occurrence,
one
or
two
months
before
the
termination
of
normal
pregnancies.
In
early
pregnancies
I
have
also
noted
this,
and
observed
that
the
pregnancy
went
smoothly
on.
Probably
the
fietal
sac
has
need
of
more
room,
or
there
is
hydramnion
in
such
cases.
Hemorrhages
are
too
often
regarded
as
causing
mis-
carriage
;
if
from
the
interior
of
the
uterus,
they
are
more
likely
(front
disease
of
the
membranes
or
death
of
the
foetus)
the
consequence
than
the
cause
;
if
from
the
cervix,
there
is
in
early
pregnancy
no
necessary
disturbance
of
the
uterine
contents.
Abortion
may
come
on
in
these
cases,
as
has
been
pointed
out
by
Barnes
(Obstet.
.tifed.
and
Surg.,
vol.
ii
,
p.
232),
in
consequence
of
the
law,
"
when
haemorrhage
sets
in
from
any
given
point,
there
quickly
follows
an
attraction
of
blood
towards
the
point
of
escape."
Given
a
healthy
uterus
and
a
healthy
foetus,
it
is
extremely
difficult
to
dislodge
the
latter,
except
at
a
monthly
period.
Some
women
abort
on
the
slightest
provocation,
although
seemingly
healthy.
Others,
as
I
have
known,
may
undergo
the
most
extraordinary
exer-
tions,
jump
high
gates,
dance,
or
run
without
inconvenience.
Thus,
in
estimating
the
value
of
any
drug
as
an
arrester
of
uterine
action,
many
side
issues
need
consideration.
At
the
same
time,
given,
more
especially
in
primiparte,
a
gaping
os
with
sonic
part
of
the
ovum
protruding,
attended
by
rhythmical
uterine
contractions
and
humor-
rhage,
then,
if
viburnum,
or
anything
else,
arrest
the
progress
of
abortion,
it
is
well
that
the
profession
should
know
it.
Even
with
hemorrhage
and
a
patent
os,
if
we
cannot
feel
the
ovum
and
the
pains
be
irregular,
while
miscarriage
is
likely,
it
is
by
no
means
cer-
tain.
I
have
seen,
as
must
everyone
with
experience,
many
cases
"
settle
"
under
most
diverse
treatment—sedatives,
for
example,
opium
or
chloral
;
astringents,
as
gallic
acid
or
acetate
of
lead,
or,
per-
Laps
better
than
these,
hamainelis
;
vascular
sedatives,
as
bromides,
digitalis,
antimony,
or
viburnum.
In
typical
abortion,
the
ovum
is
separated
front
the
uterus,
and
haemor-
rhage
follows
;
it
may
have
caused
the
separation
;
the
internal
os
is
first
dilated,
then the
cervix,
and
lastly
the
os
externum.
Now,
can
viburnum
be
depended
on
after
such
a
process
has
begun
?
I
think
we
must
rather
regard
it
as
a
preventive
drug
in
"
habitual
"
abor-
tion,
if
given
with
a
view
to
regulate
uterine
action,
than
as
an
arrester
of
the
immediate
causes
of
abortion.
In
my
own
practice,
I
have
ex-
petienced
doubt
when
to
prefer
it
to
chlorate
of
potash
;
I
hate
com-
bined
the
drugs
in
some
cases
with
good
effect.
In
cases
where
we
suspect
constitutional
affection,
I
prefer
mercury
and
iron,
given
together,
so
that
the
former
drug,
while
exercising
its
special
in-
fluence,
may
not
unduly
affect
the
red
blood-corpuscles.
Iron
has
been
looked
on
.
as
an
abortifacient
;
my
experience
contradicts
this.
As
an
example
of
the
benefits
of
other
means
than
virburnum,
I
may
mention
that,
ten
years
ago,
I
succeeded
in
bringing
a
pregnancy
to
a
successful
termination
at
full
time
after
ten
successive
mis-
carriages.
DAMP
AND
DIPHTHERIA.
BY
H.
NELSON
HARDY,
F.R.C.S.En.,
Divisional
Surgeon,
Metropolitan
Police.
A
SERIFS
of
cases
of
diphtheria
which
has
occurred
in
connection
with
one
of
the
Dulwich
police-stations,
seems
to
show
that
there
are
good
grounds
for
the
belief
that
there
is
some
special
connection
be-
tween
damp
houses
and
the
development
of
diphtheria;
though
other
unsanitary
conditions,
no
doubt,
powerfully
contribute
to
prepare
a
soil
favourable
to
the
spread
of
the
disease.
The
cases
I
am
about
to
relate
occurred,
for
the
most
nart,
in
the
persons
of
strong,
able-bodied
young
men.
There
was
no
evidemie
cif
the
disease
in
the
neighbourhood
at
the
time
;
indeed,
inqu
iries
made
of
the
sanitary
authorities
of
the
district
showed
that,
with
the
excep-
tion
of
the
police
affected,
the
district
was
singularly
free
from
the
disease
and
the
one
thing
in
common
to
all
the
patients
was,
that
they
were
more
or
less
intimately
connected
with
a
damp
and
un-
healthy
station,
their
duty
obliging
some
of
them
to
live
in
it,
and
all
of
them
to
be
in
it
for
a
considerable
portion
of
each
day.
The
station
is
an
old
dwelling-]rouse,
consisting
of
two
storeys,
not
origin-
ally
built
for
a
police-station,
but
converted
into
one
some
years
ago,
before
sanitary
considerations
began
to
occupy
so
much
attention
es
they
do
now,
and
the
water-closets
and
drains
had
never,
previously
to
this
outbreak
of
diphtheria,
been
in
a
satisfactory
state.
Two
fami-
lies
belonging
to
the
force
had
occupied
the
rooms
not
used
as
polite-
offices
;
namely,
an
inspector
and
his
wife
and
family,
having
two
rooms
on
the
ground-floor,
and
one
on
the
first-floor
;
and
a
mounted
constable
and
his
wife
and
children,
occupying
the
remainder
of
the
upper
rooms.
On
December
24th,
1884,
a
constable,
aged
19,
who
had
been
less
than
six
months
in
the
force,
and
had had
no
previous
illness
while
in
it,
had
a
pretty
severe
attack
of
diphtheria,
was
convalescent
on
January
7th,
1885,
and
was
then
granted
a
month's
sick
leave,
re-
turning
to
duty
on
February
7th,
1885.
On
January
29th,
1885,
the
mounted
constable,
aged
30,
already
referred
to
as
living
in
the
upper
rooms
of
the
station,
who
had
been
twelve
years
in
the
force,
and
whose
only
illness
had
been
an
attack
of
diarrhcea,
was
attacked,
bad
a
pro-
longed
and
very
severe
illness,
was
not
convalescent
till
the
begin-
ning
of
March,
and
was
then
granted
a
month's
leave.
On
February
20th,
1885,
a
constable,
aged
25,
who
had
been
two
years
in
the
force
without
any
previous
illness,
took
diphtheria,
had
it
slightly,
was
convalescent
on
March
2nd,
and
was
then
granted
a
month's
leave
of
absence.
On
April
13th,
1885,
a
constable,
aged
32,
who
had
been
six
years
in
the
force,
and
had
no
illness
of
importance
during
that
time,
but
whose
duties
rendered
it
necessary
for
him
to
spend
more
hours
in
the
station
than
most
of
the
other
men
did,
took
the
disease
not
very
severely
;
on
April
28th
he
was
convalescent,
and
was
then
granted
the
usual
month's
leave
of
absence.
After
this,
there
was
a
lull
for
about
six
months,
during
which
no
more
cases
appeared
amongst
those
connected
with
the
station;
and
it
was
hoped
that
certain
measures
which
had
been
taken
to
remedy
the
sanitary
defects
of
the
building,
had
proved
successful
in
checking
the
spread
of
the
disease,
a
supply
of
water
having
been
laid
on
to
the
men's
urinal
for
the
first
time,
and
a
water-closet
which
ventilated
into
the
men's
parade-room
having
been
closed.
I
should
add
that
the
whole
station
is
condemned,
and
only
used
until
a
new
one
can
be