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COATES POPULAR MEDICINE: POPULAR MEDICINE; Consisting of outlines of Anatomy, Physiology, and Hygiene, with such Hints on the Practice of Physic, Surgery, and the Diseases of Women and Children, as may prove useful in families when regular Physicians cannot be procured: Being a Companion and Guide for intelligent Principals of Manufactories, Plantations, and Boarding Schools: Heads of Families, Masters of Vessels, Missionaries, or Travellers, and a useful Sketch for Young Men about commencing the Study of Medicine. BY REYNELL COATES, M. D. Fellow of the College of Physicians of Philadelphia—Honorary Member of the Philadelphia Medical Society—Correspondent of the Lyceum of Natural History of New York—Member of the Academy of Natural Sciences of Philadelphia—Formerly Resident Surgeon of the Pennsylvania Hospital, &c. Assisted by several Medical friends. 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The Hand: Its Mechanism and Vital Endowments as Evincing Design. By Sir Charles Bell, K. H., F. R. S. With numerous wood cuts. V. Chemistry, Meteorology, and the Function of Digestion. By Wm. Prout, M. D., F. R. S. VI. The History, Habits and Instincts of Animals. By the Rev. Wm. Kirby, M. A., F. R. S. Illustrated by numerous Engravings on Copper. VII. Anatomy and Vegetable Physiology Considered with Reference to Natural Theology. By Peter Mark Roget, M. D. Illustrated with nearly Five Hundred Wood Cuts. VIII. Geology and Mineralogy, Considered with Reference to Natural Theology. By the Rev. Wm. Buckland, D. D. with numerous engravings on copper, and a large coloured map. ? The work of Buckland, Kirby and Rojet may be had separate. Footnotes: [1] On the Ova of Man and Mamiferous Animals, &c.: by T. Wharton Jones. (Med. Gaz.) [2] “Inde vero cum viderum viviparorum testes ova in se continere, cum eorundem uterum itidem in abdomen, oviductus instar apertum notarim, non amplius dubito quin mulierum testes ovario analogi sint, quocunque demum modo ex testibus in uterum, sive ipsa ova, sive ovis contenta materia transmittatur, ut alibi ex professo ostendam, si quando dabitur partium genitalium analogiam exponere, et errorem illum tollere quo mulierum genitalia genitalibus virorum analoga creduntur.” (Nicolai Stenonis Elementorum MyologiÆ Specimen, &c. Amst. 8vo. p. 145.) [3] “Ova in omni animalium genere reperiri confidenter asserimus, quandoquidem ea non tantum in avibus, piscibus tam oviparis quam viviparis, sed etiam quadrupedibus ac homini ipso evidentissime conspiciantur.” (Regner de Graaf de Virorum et Mulierum Organis Generationi Inservientibus. Lugd. B. and Roterod. 1668. 8vo. p. 299.) [4] Anat. Descript. of the Human Gravid Uterus: by W. Hunter, M. D. [5] An Exposition of the Signs and Symptoms of Pregnancy, &c.: by W. F. Montgomery, M. D. p. 226. [6] Phil. Trans. 1797. [7] Purkinje and Valentin, de Phoenomeno generali Motus vibratorii. Wratisl. 1825. [8] W. Hunter, Anatomical Description of the Human Gravid Uterus, &c. p. 13. [9] Vesalius, Malpighi, Morgagni, Diemerbroeck, Vieussens, Ruysch, Monro, Heister, Haller, Roederer, Meckel, Hunter, Wrisberg, Lobstein, C. Bell. (Meckel’s Anat. vol. iv.) [10] C. Bell, On the Muscularity of the Uterus. (Med. Chir. Trans., vol. iv.) [11] Leroux, Sur les Pertes de Sang. [12] The tortuous serpentine course which the arteries of the uterus take, is not, as has been generally supposed, a provision of nature against the increase of size which the uterus has to undergo during pregnancy, but is the result of the structure in which they ramify, having already undergone these changes during a previous pregnancy. [13] Anatomical Description of the Human Gravid Uterus, &c.: by W. Hunter, M. D. [14] The axis of the brim of the pelvis runs in such a direction, that if a line were drawn from its centre, it would pass upwards and forwards through the umbilicus: the gravid uterus has its axis rarely or never inclined less than this, and usually much more, especially in multiparÆ in whom the fundus is occasionally inclined so strongly forwards as to receive the name of pendulous belly. [15] We are inclined to think that the soft feel of the portio vaginalis is one of the earliest signs of pregnancy which can be detected by examination. Our attention was first drawn to it in an obscure case of early pregnancy, complicated with extensive disease, which we examined with Mr. Ingleby of Birmingham, and where we gave a wrong diagnosis, not considering the patient to be pregnant. If we had placed as much confidence in this symptom as we are now inclined to do, we should probably have formed a more correct view of the case. Since this we have, on several occasions, found that attending to this circumstance has considerably assisted us in determining cases of doubtful pregnancy at an early period. [16] This description is given according to the lunar not calendar months, of which there are necessarily ten during the forty weeks of pregnancy. [17] We are aware that the plan which we follow, in considering the development of the ovum, is very different to that usually adopted, and will probably be open to some objections on the score of defective arrangement; but it must be remembered that this is a work intended for students, where complete and perfect arrangement must, to a certain extent, be sacrificed in order to place an acknowledged difficult and complicated subject in the clearest and most intelligible light. We have, therefore, preferred describing first the coverings of the ovum during those periods of pregnancy at which they are most frequently seen, and shall delay its minute consideration until we come to the description of the foetus itself, the development of the one being so essentially connected with that of the other, as to render a separate description of them impossible. By this means the reader, by having the general details first brought under his notice, will be enabled to enter with more ease and advantage upon the consideration of those which are obscure and difficult. [18] Siebold’s Journal fÜr GeburtshÜlfe, vol. xiv. heft. 3. 1835. [19] On the Signs and Symptoms of Pregnancy, p. 133.: by W. F. Montgomery, M. D. In a note to the above quotation, the learned author very properly calls them decidual cotyledons, “for to that name their form, as well as their situation, appears strictly to entitle them: but from having, on more than one occasion, observed within their cavity a milky or chylous fluid, I am disposed to consider them reservoirs for nutrient fluids, separated from the maternal blood, to be thence absorbed for the support and development of the ovum. This view seems strengthened when we consider that, at the early periods of gestation, the ovum derives its support by imbibition, through the connexion existing between the decidua and the villous processes covering the outer surface of the chorion.” [20] Observations by Dr. Baillie, in the posthumous work of Dr. W. Hunter, on the Anatomy of the Gravid Uterus. [21] Observations on Certain Parts of the Animal Economy, p. 134. [22] It has lately been supposed that the irregular nodules of wax in the Hunterian preparations were merely the result of extravasation, a rather hazardous conclusion against the authority of such men as the Hunters. Mr. J. Hunter has, however, expressly met this objection in the following observation:—“this substance of the placenta, now filled with injection, had nothing of a vascular appearance, or that of extravasation; but had a regularity in its form which showed it to be a natural cellular structure, fitted to be a reservoir for blood.” (Observations on Certain Parts of the Animal Economy, p. 129.) [23] In offering these observations on the placenta, we have purposely quoted, wherever it was possible, from the admirable essays of the Hunter’s, on this subject. These works, more especially that of Dr. W. Hunter, are becoming too scarce to be easily attained by the student; and yet it is more peculiarly important to this class of our readers, that they should not only be aware how much we are indebted to these illustrious men for what we know upon the subject; but also that they should be as familiar as possible with their very words and expressions. The essays in question are master-pieces of original observation and correct description, and we may safely assert, that the one by Dr. Hunter is so complete, as to leave us little or nothing more to be wished for on this subject. With such feelings we cannot conceal our surprise, to find that an author like Dr. Burns should have passed over the whole subject of the placenta without once alluding to the name of Hunter; this omission is the more marked in the last editions of his work, where he has furnished the reader with copious references, &c. in the notes. One would have thought that Dr. Burns would have felt pride in acknowledging the merits of his distinguished countrymen. [24] We said, “one of the earliest changes.” Mr. Jones considers that “the breaking up of the surface of the yelk into crystalline forms,” is the first change which he has observed. [25] Allen Thomson on the Development of the Vascular System in the Foetus of Vertebrated Animal. (Edin. New Philosop. Journ. Oct. 1830.) [26] Pander. BeitrÄge zur Entwickelungs-gesechichte des HÜnchens im Eie. WÜrzburg, 1817. [27] In making these observations upon the formation of the ductus arteriosus, we must request our readers to consider this as still an unsettled question. [28] The vernix caseosa is a viscid fatty matter of a yellowish white colour, adhering to different parts of the child’s body, and in some cases in such quantity as to cover the whole surface; it seems to be a substance intermediate between fibrine and fat, having a considerable resemblance to spermaceti. From the known activity of the sebaceous glands in the foetal state, and from this smegma being found in the greatest quantity about the head, arm-pits, and groins, where these glands are most abundant, there is every reason to consider it as the secretion of the sebaceous glands of the skin during the latter months of pregnancy. [29] Fourcroy, it is true, has shown that the foetal blood is not only of a darker colour, but incapable of becoming reddened by the contact of atmospheric air, and that it coagulates very imperfectly. Others have shown that there is no perceptible difference in the colour of the blood of the umbilical arteries from that of the umbilical vein. Still, however, this by no means disproves what we have now stated, and which is now generally allowed to be the office of the placenta during the latter periods of pregnancy. [30] “A gentleman,” says Dr. Montgomery, “lately informed me that, being afflicted with a stepmother naturally more disposed to practise the fortiter in re than to adopt the suaviter in modo, he and all the household had learned from experience to hail with joyful anticipations the lady’s pregnancy, as a period when clouds and storms were immediately changed for sunshine and quietness.” (Exposition of the Signs and Symptoms of Pregnancy, p. 9.) [31] Dionis says, that “women of a sanguine complexion, who form more blood every month than is necessary for the nourishment of the foetus whilst it is small, discharge the overplus by the vessels which open into the vagina during the first months.” [32] The menstrual blood is more pale and sparing: it usually comes from the hÆmorrhoidal vessels of the vagina, or at most, from those of the cervix uteri. (Levret, Art des Accouchemens, § 233.) [33] Should the vessels of the cervix uteri take upon them the secretion of the menses, this discharge can thus continue through pregnancy. (Carus, Lehrbuch der Gynakologie, bd. ii. p. 67.) [34] L’Art d’Accouchemens, § 369. (note;) also Deventer, Novum Lumen Obstet. chap. xv.; Perfect’s Cases of Midwifery, vol. ii. p. 71. [Meurer, American Journ. Med. Sc., April 1841, p. 494.] [35] This fact was observed so long ago as by Aristotle, also by Schenk, as quoted by Mauriceau, lib. i. chap. 1. Mauriceau himself mentions having seen several cases, one of which forms the subject of his 393d observation. “Le 8 Juin, 1685. J’ai vu une jeune femme agÉe seulement de seize ans et demi, mariÉ depuis un an qui Était grosse de cinq mois ou environ, quoiqu’elle n’eut jamais eu ses menstrues, À ce qu’elle me dit aussi bien que son marie, qui ne pouvait pas se persuader qu’elle cÛt pÛ devenir grosse, n’ayant pas encore eu ce premier signe de fÉconditÉ; m’alleguant, pour soutenir son opinion, qu’on ne voyait jamais de fruit d’un arbre qui n’eut ÉtÉ prÉcÉdÉ de sa fleur. Mais je lui dis qu’il Était certain, comme il reconnut bien par sa propre experience en voyant accoucher sa femme d’un enfant vivant quatre mois ensuite, que les jeunes femmes pouvaient bien quelquefois devenir grosses, ainsi qu’il Était arrivÉ À sa femme, sans avoir jamais eu leur menstrues, si elles usaint du coit dans le temps mÉme quelles Étaient sur le point d’avoir effectivement cette evacuation naturelle pour le premier fois.” [36] Roederer, Elm. Art. Obst. p. 46. The original is a masterly specimen of description, not less remarkable for its singular comprehensiveness than the beauty of the style. “Menstruorum suppressionem mammarum tumour insequitur, quocirca mammÆ crescunt, replentur, dolent interdum, indurescunt; venÆ earum coeruleo colore conspicuÆ redduntur; crassescit papilla, inflata videtur, color ejusdem fit obscurior; simili colore distinguitur discus ambiens qui in latitudinem majorem expanditur, parvisque eminentiis quasi totidem papillulis tegitur.” [37] “In women with dark eyes and hair, this discolouration is very distinct; in women with light hair and eyes, it is often so slight that it is difficult to tell whether it exists or no.”... “In brunettes who have already borne children, the areola remains dark ever afterwards, so that this ceases to be a guide in all subsequent pregnancies.” (Gooch, on some of the more important Diseases of Women, p. 201 and 203.) [38] We had, at the moment of writing the above, a patient just recovered from her first labour, in whom the discolouration extended nearly over the whole breast: it was darker in some spots than in others, and presented a variety of shades not unlike a large bruise of some days’ standing. Dr. Montgomery mentions a case where the areola was almost black, and upwards of three inches in diameter. A similar case occurred not long since. [39] BibliothÈque Universalle, t. ix. p. 248; also in the Isis for 1819, part iv. p. 542. [40] “MÉmoir sur l’Auscultation appliquÉe À l’Étude de la Grossesse, ou Recherches sur deux nouveaux Signes propres À faire reconnaÏtre plusieurs Circonstances de l’Etat de Gestation; lu À l’Academie Royale de MÉdecine dans la SÉance GÉnÉrale du 26 December, 1821. Par J. A. Lejumeau de Kergaradec.” [41] Dr. Evory Kennedy, Observations on Obstetric Auscultation, &c. 1833. [42] H. F. NaegelÉ, Die GeburtshÜlfliche Auscultation, 1838; also Dr. Corrigan, Lancet. [43] Die GeburtshÜlfliche Exploration, von Dr. A. P. Hohl. [44] This sign of pregnancy has very recently excited some attention, and the researches of M. Tanchou of Paris, (see American Journ. Med. Sc. Feb. 1840, p. 483,) Golding Bird, (Ibid., Aug. 1840, p. 501,) and Drs. McPheeters and Perry, (American Medical Intelligencer, March 15th, 1841, p. 350,) conclusively establish, that taken in connexion with other symptoms, it forms a very valuable aid to diagnosis. The following is the description given by M. Tanchou of the changes which the urine during pregnancy exhibits, and of the characters by which its peculiar ingredient, named by M. Nauche Kiesteine, may be recognised. The urine of a pregnant woman, collected in the morning, is usually of a pale yellow colour and slightly milky in appearance; it is not coagulable by heat, or by any of the tests which indicate the presence of albumen. Left to itself and exposed to the air after the first day, there begins to appear suspended in it a cottony-looking cloud, and, at the same time, a flocculent whitish matter is deposited at the bottom of the fluid. These phenomena are not of constant occurrence, and, moreover, healthy urine sometimes exhibits analogous phenomena. From the second to the sixth day, we perceive small opaque bodies rise from the bottom to the top of the fluid; these gradually collect together so as to form a layer which covers the surface: this is the kiesteine. It is of a whitish or opaline colour, and may be very aptly compared to the layer of greasy matter which covers the surface of fat broth, when it has been allowed to cool. Examined by the microscope, it exhibits the appearance of a gelatinous mass, which has no determinate form. Sometimes small cubical crystals can be perceived in it, when it has become stale. The kiesteine continues in the state we have now described, for three or four days; the urine then becomes muddy, and minute opaque bodies detach themselves from the surface and settle at the bottom of the vessel: the pellicle thus becomes soon destroyed. The characteristic feature, therefore, of the urine during pregnancy consists in the presence of kiesteine. It deserves, however, to be noticed, that the urine, in some cases of extreme phthisis pulmonalis, and also of vesical catarrh, will be found to exhibit on its surface a layer or stratum which is not unlike to that now described as peculiar to the state of pregnancy. But with proper attention we may easily avoid this mistake. The stratum, in the cases alluded to, does not appear so quickly on the surface of the urine as the kiesteine does; and also, instead of disappearing, as it is found to do, in the course of a few days, it (the former) goes on increasing in thickness, and ultimately becomes converted into a mass of mouldiness. Of twenty-five cases, in which M. Tanchou detected the presence of kiesteine in the urine, seventeen occurred in women who were pregnant from four to nine months, four in women who had not quickened, and who considered themselves as labouring under disease of the womb, and the remaining four in patients who had been under treatment for casual complaints—one for sciatica at the HÔtel Dieu, another for ascites in the city, a third for an ulcer in the neck at La PitiÉ, and the last had been cauterized twice a week for a pretended disease of the uterus. In none of these cases had the existence of pregnancy been suspected, although in every one of them the fact was soon placed beyond doubt.—Editor. [45] Baudelocque wrote an account of it to Professor NaegelÉ of Heidelberg, from whom we received the particulars. [46] See Treatise on the Diseases of Females, 6th ed. p. 46. Ed. [47] Ovum deforme, in quo partes embryonis et secundarum distingui vix possunt, molam vocabimus. (Roederer, Elementa Artis ObstetricÆ, § 738.) [48] Dr. J. Y. Simpson on the Diseases of the Placenta. (Edin. Med. and Surg. Journal, April 1, 1836.) [49] “One must be careful not to mistake these clots of blood, which being washed by the reddish serosities which flow from the womb, harden in the vagina, or womb itself, and look exactly like false conceptions.” (La Motte.) “Every mole is a blighted ovum which has been the product of conception. We are not justified in classing under the head of moles every mass which is produced and lodged within the uterus.” (Froriep’s Handbuch der GeburtshÜlfe, § 180.) [50] Our friend, Dr. Nebel, of Heidelberg, has a preparation of a foetus which was retained for fifty-four years in the abdomen. This is the longest period on record of a foetus being retained in the cyst of a ventral pregnancy. Many other cases have been described. (See Burns, 9th edition, where the notes contain very ample references.) [51] We had lately a case of this kind. The patient had been under our care for inflammation of the cervix uteri. There was that general enlargement of the uterus which attends this condition; and, on endeavouring to lift a heavy weight, she was seized with violent pain in the pelvis, great difficulty in passing fÆces and urine, and, on examination, the uterus was found retroverted. The bowels were well opened with castor oil, and in a day or two it recovered its natural position. [52] Dr. W. Hunter has evidently taken the same view of the case, and invariably considers retention of urine as an effect, not the cause, of this displacement. (Med. Observ. and Inq. vol. iv.) [53] We were once misled in a case of this description. The os uteri lay close behind the symphysis pubis, and its opening, as well as so much of the neck as we could feel, looked straight downwards. We were unable to pass the finger sufficiently high to trace the continuity between the neck of the uterus and tumour in the hollow of the sacrum formed by the fundus; and the haggard aged appearance of the woman put all suspicion of pregnancy out of our mind. [54] Dr. Burns makes a similar observation. “In most cases the cervix will be found more or less curved; so that the os uteri is not directed so much upwards as it otherwise should be.” (Principles of Midwifery, p. 281. 9th edit.) [55] “Sometimes it is perhaps better to introduce the fingers into the vagina only, and not into the rectum, not merely because, we can act better and more directly upon the uterus here, but also because if we press the posterior wall of the vagina upward towards the sacrum, and thus stretch the upper part of it which is between the fingers and the os uteri, it will act upon the uterus like a cord upon a pulley, and greatly favour its rotation.” (Richter, op. cit. vol. vii. sect. 57.) [56] Among others, we may mention an exceedingly interesting case recorded by Mr. Baynham, in the Edin. Med. and Surg. Journ. April, 1830. The real nature of the case was not ascertained for six weeks, the catheter only being used night and morning. Even when the bladder was empty, the fundus resisted every attempt to return it. The most prominent part of the tumour in the rectum was punctured with a trocar, and about twelve ounces of liquor amnii, without blood, were drawn off: the reduction followed in about a quarter of an hour. A full opiate was given, and the patient passed a better night than she had done before. Twenty-five hours after the operation, the foetus, was expelled; it was fresh, and about the size of a six months’ child. The patient recovered. [57] Dr. Cheston’s case, where the child was afterwards carried the full time, and born alive. (Med. Communications, vol. ii. p. 6.) [58] Merriman, Med. Chir. Trans. Vol. xiii. p. 338. [59] Exposition of the Signs and Symptoms of Pregnancy: by W. F. Montgomery M. D. p. 253. [60] Dewees, Compendious System of Midwifery, sect. 408. A similar case is recorded by Dr. Montgomery. [61] “Qui inter septimi et noni mensis, À prima conceptione, finem contingit partus, prÆmaturus vocatur: abortus vero quando ante dictum tempus embryo excidit; id quod circa tertium graviditatis mensem ut plurimum accidit. Vitalem esse prÆmaturum foetum observatio nos docet, embryonem autem non manere superstitem constat.” (Roederer, Elem. Artis Obst. cap. xxiii. § 716.) [62] During the great influenza epidemic, abortions were remarkably frequent. [63] This is nearly the same arrangement which has been followed by Dr. Copland, in the article Abortion, in the Dict. Pract. Med. [64] This crotchet consists of a piece of steel of the thickness of a small quill at its handle, and gradually tapered off to its other extremity which is bent to a hook of small size. (See accompanying figure which represents the instrument one third the natural size.) This instrument is highly useful in cases in which the flooding continues after the ovum has been broken and its contents expelled. A portion of the involucrum sometimes insinuates itself into the neck of the uterus, and prevents the degree of contraction necessary to interrupt farther bleeding. This accident most frequently attends the earlier abortions. As hÆmorrhage is maintained by the cause just named it suggests the propriety of never breaking the ovum; especially before the fourth month. When the flooding is maintained by this cause, it will not cease but upon the event of its removal. This condition of the placenta and neck of the uterus is easily ascertained by an examination; it will readily be felt to be embraced by the neck of the uterus; and though a portion may protrude a little distance below the os tincÆ, it cannot be extracted by the fingers; for the os uteri or cavity of the uterus will not be sufficiently large to permit the fingers to pass into it, that this mass may be removed; the crotchet should then be substituted; the mode of using it is as follows:—The fore-finger of the right hand is placed within or at the edge of the os tincÆ; with the left we conduct the hooked extremity along this finger, until it is within the uterus; it is gently carried up to the fundus, and then slowly drawn downwards, which makes its curved point fix in the placenta; when thus engaged, it is gradually withdrawn, and the placenta with it. Dr. Dewees says, that in every case in which he has used this crotchet, the discharge instantly ceased. See Art. “Abortion,” by Dr. Dewees, in American Cyclopedia of Pract. Med. and Surg. Dr. Dewees “from some late experience is induced to believe” that “in cases in which we cannot command the removal of the placenta by the fingers—that is, when this mass continues to occupy the uterine cavity, or but very little protruded through the os tincÆ,” the administration of ergot, will often supercede the necessity of the crotchet. Treatise on the Diseases of Females. Sixth Edition, p. 351.—Ed. [65] Dr. Dewees recommends the crotchet only where the flooding continues after the ovum has been broken. See preceding note. Ed. [66] “Clysteres injiciantur, quorum irritatione expultrix uteri facultas excitatur, et depleta intestina ampliorem locum utero relinquat.” (Riverius, Prax. Med. de Partu difficili.) [67] [Dr. Dewees recommends the woman to be placed for labour on her left side at the foot of the bed, in such a manner as will enable her to fix her feet firmly against one of the bed-posts; her hips within ten or twelve inches of the edge of the bed; her knees bent, her body well flexed upon her thighs; her head and shoulders will then be near the centre of the bed, where pillows should be placed to raise them to a comfortable height. This is the position we believe in which the patient is very generally placed in the United States.—Ed.] [68] [See an interesting paper “on Laceration of the Perineum during Labour; by Wm. M. Fahnestock, M. D.,” in American Journal of the Med. Sc. for Jan. 1841. Editor.] [69] See a case of central perforation of the perineum, Med. Gaz. p. 782. Aug. 19, 1837. [70] “The practice of using force to hurry the shoulders and body of the child through the os externum as soon as the head was born, is very generally laid aside. There can be no doubt that this imprudent conduct often brought on a retention of the placenta.” (See White, on Lying-in Women.) [71] “A ligature upon the navel string is absolutely necessary, otherwise the child will bleed to death; and when tied slovenly, or not properly, it will sometimes bleed to an alarming quantity. As we take such vast care to secure the navel string, you will naturally ask how brutes manage in this particular? I will give you an idea of their method of procedure, by describing what I saw in a little bitch of Dr. Douglas. The pains coming on, the membranes were protruded; in a pain or two more they burst, and the puppy followed. You cannot imagine with what eagerness the mother lapped up the waters, and then, taking hold of the membranes with her teeth, drew out the secundines; these she devoured also, licking the little puppy as dry as she could. As soon as she had done I took it up, and saw the navel string much bruised and lacerated. However, a second labour coming on, I watched more narrowly, and as soon as the little creature was come into the world I cut the navel string, and the arteries immediately spouted out profusely; fearing the poor thing would die, I held it to its mother, who, drawing it several times through her mouth, bruised and lacerated it, after which it bled no more. This, I make no doubt is the practice with other animals.” (Dr. W. Hunter’s Lectures, MS. 1752; from Dr. Merriman’s Synopsis, p. 21. note.) [72] Carus’s Gynakologie, vol. ii. p. 138. This assertion, however, must be qualified, somewhat, as we know of several cases where flooding has come on after labour during sleep. [73] “I have observed,” says Dr. Hunter, “in women who do not give suck, and in nurses after they leave off suckling, that the axillary glands become painful, swell, and sometimes suppurate. Is not this owing to the acrimony which the milk has acquired by long stagnation in the breast, and affecting the gland through which it must pass in absorption? I have observed that they are at the same time liable to little fevers of the intermitting kind, which come on with a rigour, and go off with a sweat. Are not such fevers raised by absorption of acrid milk?” (Hunter’s Commentaries, p. 59.) [74] [The best application we have ever tried, is the vinegar and water as is commended by Dr. Dewees. See his admirable chapter on Milk Abscess. Treatise on the Principal Diseases of Females.—Am. Ed.] [75] [Sore nipples is an affection, of so very frequent occurrence, often so exceedingly obstinate, and sometimes productive of such extreme torture to the patient, that some additional remarks relative to its treatment may be acceptable to the practitioner. The solution of nitrate of silver, two grains to the ounce of water, is highly extolled by Mr. Allard (American Journ. Med. Sc. Feb. 1837,) and Dr. Churchill says that he has found it the most effectual application. (Diseases of Pregnancy and Child-bed.) This solution should be applied every time the child is taken from the breast, care being taken to wash the nipple previous to the next application of the child. We have frequently found this treatment very efficacious, but in some cases it entirely fails. Dr. Hannay says, that the solution is inferior to the solid nitrate of silver, and asserts that the latter never fails to afford relief and ultimately effect a cure. He uses it as follows. The nipple is to be gently and carefully dried, then freely touched with a sharp pencil of nitrate of silver, care being taken to insinuate the pencil into the chaps or chinks. The nipple is then to be washed with a little warm milk and water. The pain though smart soon subsides, and all that is necessary, according to Mr. H. to heal the sore, is a little simple ointment, or one made with the flowers of zinc. When the pain from the application is very severe, relief should be given by the administration of thirty drops of the solution of morphium. In some cases it is necessary to apply the caustic more than once. (Am. Journ. Med. Sc. Feb. 1835, p. 527.) Dr. Chopin recommends repeated lotions with the solution of Chloride of Soda, which he says will often cure in one or two days. (Am. Journ. Med. Sc. May, 1836.) Dr. Bard says that simply keeping a linen cloth constantly wet with rum over the nipple is frequently very useful, and as it is one of the easiest remedies, it should be first tried. (Compendium of the Theory and Practice of Midwifery.) Stimulating ointments, such as ung. hydrarg. rub. diluted with lard, is, according to Burns, sometimes of service, as is also touching the parts with burnt alum, or dusting them with some mild dry powder. Solutions of sulphate of alumine and of sulphate of copper, of such strength as just to smart a little, are also recommended as occasionally of service by the last named practitioner. (Principles of Midwifery, 7th Ed. p. 543.) We have found Kreosote, three to six drops in an ounce of water, very efficacious; in some cases affording more speedy relief than any other application. The mucilage of the slippery elm applied cold is often a most comfortable application, and its efficacy is sometimes increased by dissolving in it some borax. When all these means fail, the mother must give up suckling for a time, when the parts heal rapidly. This last resource will not be often necessary. The great number of remedies which have been employed for the cure of this complaint sufficiently attest its obstinacy. This obstinacy is owing, in some cases, we conceive, to an irritable condition of the patient’s system, a fact overlooked so far as we know, by most practitioners. In such cases a mild and nutritious diet, fresh air, keeping the bowels free, &c. will do more towards effecting a cure than local applications; though the latter even here are not to be neglected. Editor.] [76] [Dr. Dewees regards after-pains as an evil of magnitude, and always endeavours to prevent them as quickly as possible. For this purpose he recommends camphor or some preparation of opium. (See his System of Midwifery.) We have always adopted this practice to the great relief of the patient, and have never had cause to regret it. Dr. Dewees’s observations on this subject should be attentively perused.—Ed.] [77] See observations on Malposition of the Child. [78] We have no words in the English language like the schrag and schief of the German to express these different species of obliquity. [79] On the other hand, Dr. Merriman observes, that he has “twice known the presentation of the face converted by the pains alone into a natural presentation.” (Synopsis, p. 48.) [80] According to the results of Dr. Collins’s experience at the Dublin Lying-in Hospital, the face presented once in about every 504 cases; but as, in several labours, the presentation was not noted on account of their rapidity, the proportion is probably larger. [81] Madame La Chapelle calls this the courboure des bords, to distinguish it from the head curvature, courboure des faces (p. 61.) [82] A Treatise on the Improvement of Midwifery, chiefly with regard to the Operation: by Edmund Chapman, 2d edit. 1735. [83] [Dr. Dewees, prefers, in all cases, the long forceps. See the chapters on the Forceps in his System of Midwifery. Ed.] [84] See Midwifery Hospital Reports, case of Mrs. Worsley, May 3, 1834, p. 187. [85] Another circumstance is humanely insisted on by Madame la Chapelle with much propriety: “Je ne manque jamais de fair voir le forceps À la femme, et de lui expliquer À-peu prÈs son usage, et sa faÇon d’agir. Il n’en est aucune que cette dÉmonstration ne tranquillise, et j’en rencontre souvent qui À leur deuxieme accouchement sollicitent l’application du forceps qu’elles ont vu mettre en usage pour les dÉbarasser du premier.” (Pratique des Accouhemens, p. 64.) [86] Madame la Chapelle confirms this mode of introducing the forceps: “Pour moi, je l’introduis constamment sur le ligament sacro-sciatique.” (Pratique des Accouchemens, p. 66.) [87] “Quand une fois la tÊte est hors les parties osseuses, elle ne retrograde plus, je les dÊsarticule (the blades) avec la clef placÉe entre elles en forme de lÉvier; je les extrais en les inclinant graduellement, car souvent l’extraction un peu brusquÉe d’une branche produit l’expulsion de la tÊte.” (La Chapelle.) [88] “Mon avis est que la choix n’est point nÉcessaire quand l’uterus est encore rempli d’eau, et que la position est douteuse. En pareil cas je conseillerais mÊme plutÔt de faire usage de la main droite, quoique, pour mon compte, l’habitude m’ait rendu l’usage aussi familiar que celui de l’autre.” (Mad. la Chapelle, Prat. des Accouch. p. 88.) [89] “Une chose trÈs importante À observer quand on se trouve contraint par la perte de sang À en venir À l’opÉration, et que les eaux ne sont point encore ouvertes, c’est de couler la main tantÔt À droit, tantÔt À gauche le plus haut et le plus doucement qu’il est possible de long les membranes qui contiennent les eaux sans les rompre, jusqu’ À ce qu’ on ait trouvÉ les pieds de l’enfant pour s’en saisir. Car s’il arrive qu’elles se rompent avant qu’on ait pris cette prÉcaution, pendant qu’on les cherche, les eaux s’Écoulent, les sang se perd, a la matrice se referme en partie, et l’opÉration devient par-lÀ plus difficile et plus dangereuse.” (Pratique des Accouchemens, p. 277.) [90] TraitÉ des Accouchemens, 1770. § 691. “Pour moi, j’ai toujours au contraire trouvÉ un grand advantage À insinuer la main jusqu’aux pieds de l’enfant, et À n’ouvrir les membranes qu’en saisissant ces derniers.” (La Chapelle p. 90.) [91] “We must by no means burst the bag of liquor amnii until the hand has passed up between the membranes and the uterus. Every movement is easy whilst there is fluid in the uterus: hence, therefore, we must not withdraw the hand until we have fairly gained the feet and brought them down; for otherwise the waters escape, the uterus contracts, and the rest of the operation is more difficult.” (Boer, vol. iii. p. 17. note.) [92] “Je suis loin de prÉtendre, avec Puzos, que la traction sur un seul pied ait les avantages rÉcis.” (La Chapelle, p. 93.) [93] “Dans tous ces accouchemens je laisse le plus souvent agir la nature, et je le fais avec bien plus de sÉcuritÉ quand je sÇais que la femme a accouchÉ prÉcÉdemment et fort aisÉment d’enfans volumineux, quand je reconnois son bassin pour avoir toutes les dimensions requises, quand les contractions de la matrice sont bonnes.” &c. (TraitÉ des Accouchemens, § 674.) [94] Ueber die kÜnstliche Wendung auf den Steiss, in the Heidelberg Klin. Annalen, vol. ii. part i. p. 142. [95] TraitÉ des Hernies, contenant une ample DÉclaration, &c., par Pierre Franco de Turriers en Provence, demeurant À presÉnt À Orange: À Lyon, 1561. [96] See Dystocia from Malposition of the Child. [The student who desires to investigate this subject farther, may consult Dr. Churchill’s Researches on Operative Midwifery. Essay ii. on Version.—Am. Ed.] [97] [Prof. Gibson has operated twice on the same patient, and both times successfully, for mother and children. See American Journal, for May 1838.—Ed.] [98] [Dr. Churchill has collected the statistics of 409 cases of CÆsarean section, of which number, 228 mothers were saved; and 181 lost, or about 1 in 2¼: and out of 224 children, 160 were saved, and 64 lost—or about 1 in 3½. Of the above cases, 40 occurred in the practice of British practitioners, of which, 11 mothers recovered, and 29 died; or nearly three fourths—and 37 cases, in which the result to the child is mentioned, 22 were saved, and 15 lost—or 1 in 2½. Of 369 cases in the practice of Continental practitioners, 217 mothers recovered, and 152 died, or 1 in 2?—and out of 187 cases, where the result to the child is given, 138 were saved, and 49 lost; or nearly 1 in 4. Researches on Operative Midwifery. By F. Churchill, M. D., Dublin, 1841. Editor.] [99] [The propriety of an early resort to the CÆsarean section, in cases where it is necessary, has been very properly insisted upon; but the circumstances which render it necessary, are not always readily determined. M. Castel states, that in a case at the hospice de perfectionnement, in which the operation was determined on, some delay became necessary in order to find accommodation for the crowd of students who collected to witness it, and before this could be effected the woman was delivered naturally. M. Gimelle says, that at the hospital of M. Dubois, a small woman, who had five times submitted to the CÆsarean section, was delivered naturally the sixth time. Am. Journ. Med. Sc. Aug. 1838. Ed.] [100] For the particulars of this interesting case we must refer our readers to the British and Foreign Med. Review, vol. ii. p. 270; and also to vol. iv. p. 521. [Also to American Journal Med. Sc., August, 1838, p. 526, and Nov. 1837, p. 244.—Ed.] [101] [Those who desire farther information on this subject, may consult, with advantage, Dr. Churchill’s Researches, already quoted.—Ed.] [102] Dr. Macauley was physician to the British Lying-in Hospital, in Brownlow Street, and colleague of Dr. W. Hunter. [103] Barlow, Medical Facts and Observations, vol. viii. Although we are in great measure indebted to Dr. Denman for having brought this operation into general notice, it is to the late Professor May, the father-in-law of Professor NaegelÉ, that the merit is due for having first pointed out the advantage of exciting uterine contraction before rupturing the membranes. (Programma de Necessitate PartÛs quandoque prÆmature, vel solo Instrumentorum adjutorio promovendi. Heidelberg, 1799.) [104] [The student who desires to investigate this subject farther, is referred to Dr. Churchill’s Researches on Operative Midwifery, and a copious analysis of his Essay on Premature Labour, in the American Journ. Med. Sc. for Nov. 1838, p. 172, also to the Nos. of the Journal just named, for Feb. 1838, p. 516, November 1839, p. 237, and July 1841, p. 226. Editor.] [105] “The scissors ought to be so sharp at the points as to penetrate the integuments and bones when pushed with moderate force, but not so keen as to cut the operator’s fingers or the vagina in introducing them.” (Smellie, vol. i. chap. 3. sect. 7. numb. 2.) [106] [Dr. Churchill who has collected the statistics of this operation, states, that in 334,258 cases of labour, the crotchet has been used in 343, or 1 in 974½. Of this number, 41,434 cases of labour occurred to British practitioners; in which, there were 181 crotchet cases, or about 1 in 228. Among the French, 36,169 cases of labour; of which there were 30 crotchet cases, or 1 in 1,205?. And among the Germans, 132 crotchet cases, in 256,655 labours, or 1 in 1,944?. Of 251 cases, in which the result to the mother is given, the mortality was 52, or about 1 in 5. (Op. Cit.) Editor.] [107] The above arrangement is that which is given by Professor NaegelÉ, in his Lehrbuch der GeburtschÜlfe. [108] Pratique des Accouchemens, p. 21. “Je puis assurer n’avoir jamais rencontrÉ aucune position du col, ni du tronc proprement dit.” (p. 19.) [109] Merriman’s Synopsis of difficult Parturition, last edition, p. 69. The elongated form of the protruded bag of membranes is, however, by no means a constant occurrence, as cases frequently occur where nothing of the kind has appeared. [110] Boer’s Naturliche GeburtshÜlfe, b. iii. p. 64. A case of actual evolution has also been described by Mr. Barlow, p. 399. [111] Med. Chir. Trans., case by Dr. Smith, of Maidstone. See also an interesting case by Professor NaegelÉ, in the British and Foreign Medical Review, where the uterus was ruptured by sudden violence, part of the child was delivered per vaginam, the rest by an abscess through the abdominal parietes. No. x. April, 1838. [112] Lassus, Pathologie Chirurgicale, tom. ii. p. 237, quoted by Dr. M’Keever, op. cit. p. 27. [113] Collins, op. cit. p. 277. An interesting case of rupture at the sixth month, is recorded by Mr. Ilot, of Bromley, in the seventh volume of the Medical Repository, and quoted by Dr. Merriman, who has also given another at the eighth month by Mr. Glen, p. 268. See also an interesting case in the Brit. and For. Med. Rev. for October, 1838, p. 539. [114] [Another case is recorded by Dr. Carmichael, of Dublin. See Amer. Journ. Med. Sc., May 1840, p. 236.—Ed.] [115] The late Professor Young, of Edinburg, has described a case of this sort in his lectures: he distinctly “heard the head crack, and a large quantity of fluid came away.” [116] Observationes AnatomicÆ, 52. A similar case has been recorded by Dr. Wrangel, in the Archiv. der Gesellschaft der Correspondirenden Aerzte zu St. Petersburg. When called to the case, the forceps had been already applied by a colleague, but could not be locked, owing to the enormous tumour of the head. A doughty swelling was felt between the blades of the forceps, of such a size that he could only just reach the cranial bones. He made pretty strong traction twice, when unluckily the instrument slipped off; it seemed, however, to have brought the head so much lower, that the child was delivered in ten minutes afterwards by the natural efforts: it was dead. A sac filled with serous fluid, and as large as the head itself, was attached to the occiput; it was covered by the cranial integuments, and in ten hours afterwards, as the fluid had found its way through the open sutures into the cranial cavity, the tumour had the appearance of a hydrocephalus. [117] Quoted by Dr. Lee in the Med. Gazette, Dec. 25, 1830, from the Journ. GÉn. de MÉd. tom. xliii. xlv. [118] Merriman’s Synopsis, p. 216.; also Dr. J. Y. Simpson’s fifth case of fatal peritonitis, in Edin. Med. and Surg. Journ. No. cxxxvii. The patient had suffered under four different attacks of venereal disease. Some interesting cases have been published in the Neue Zeitschrift fÜr Geburtskunde, band vii. heft 1. by Dr. Bunsen of Frankfort and Dr. Kyll of Cologne. In almost every case of great accumulation of liquor amnii, the child was dead, hydrocephalic, or with ascites and in many the placenta was diseased. [119] [Dr. Churchill has given a table of the length of the umbilical cord in 500 cases. In 127 of these, the cord was 18 inches long, in 77 cases 24 inches, and in 45 cases 20 inches long. The extremes were 12 and 54 inches. Op. Cit.—Ed.] [120] In a case of this sort Mauriceau says, “Ce noeud Étoit extrÉmement serrÉ: mais cela ne s’etoit fait seulement que dans la sortie de l’enfant; car s’il eÛt ÉtÉ long-temps serrÉ de la sorte dans le ventre de la mÈre, l’enfant auroit certainement peri; À cause que le mouvement du sang que lui Étoit nÉcessaire, auroit ÉtÉ entiÈrement interceptÉ dans ce cordon. J’ai encore accouchÉ depuis ce temps la, sept autres femmes, dont les enfans qui Étoient tous vivans, avoient pareillement le cordon noÜÉ d’un semblable noeud qui s’Étoit fait de la mÊme maniÈre, par l’extraordinaire longueur de leur cordon.” (Obs. 133.) [121] [Dr. Zollickoffer, of Middleburg, Md., relates two cases, in each of which there was a knot upon the cord without any injury to the children. American Journal, Med. Sc. July 1841, p. 109.—Ed.] [122] Van Swieten, in his Commentaries on Boerhaave, gives a remarkable instance of its occurring twice in the same patient, so as to destroy the child. “I had occasion to see two instances of the birth of a dead child in one lady of distinction, where every thing was exactly and rightly formed; only the navel string was, towards the middle, twisted into a firm knot, so that all communication between the mother and foetus had been intercepted. The umbilical rope seems to have formed by chance a link, through which the whole body of the foetus passed, and afterwards, by its motion and weight, had drawn the knot, already formed, into such a degree of tightness, that the umbilical vessels were entirely compressed; for when the knot was loosened out, all that part of the navel string which was taken into the knot was quite flattened.” (Vol. xiii. § 1306.) [123] One of the most remarkable cases of extreme pelvic deformity from mollities ossium is described by Professor NaegelÉ in his Erfahrungen und Abhandlungen. The patient was the mother of six living children when she was attacked with the disease: the seventh, after great difficulty, was born dead, and the eighth was delivered by the CÆsarean operation, which proved fatal. The spine was pressed so downwards, that the third lumbar vertebra was opposite to the superior edge of the symphysis pubis; the distance of the left ramus of the pubes from the fourth lumbar vertebra was only 2½ lines; the transverse diameter of the inferior aperture only 1 inch 9 lines. For the farther details of this interesting case we may refer to our published lectures on this subject. A similar and highly interesting case has been recorded by Mr. Cooper, and communicated by Dr. Hunter in the Medical Observations and Inquiries, vol. v. The patient’s first three labours were rather easy; in the beginning of her fourth pregnancy she had a violent rheumatic fever, which continued about six weeks; from this time she never enjoyed good health and suffered constantly from rheumatic pains over her whole body: these were followed by laborious respiration, and gradual distortion of spine: her fourth labour was accomplished with much difficulty. During her fifth pregnancy the distortion continued to increase. In her sixth and seventh labours the pelvis was found much contracted, so much so in the last as to require perforation. In her eighth labour the pelvis then appeared to be somewhat less than 2½ inches from the symphysis of the ossa pubis to the superior and projecting part of the os sacrum, and otherwise badly formed. Embryotomy was again performed. She had become much more deformed and helpless, but in three years afterwards she was again pregnant. “She now appeared to be little more than an unwieldy lump of living flesh.” The antero-posterior diameter was now only 1¼ inch, becoming gradually narrower at each side. The CÆsarean operation was performed with a fatal result. On examination after death, the rami of the ischium were found “little more than half an inch asunder.” [124] [A second case has been recorded by Dr. Schultzen, see American Jour. Med. Sc. July 1841, p. 238.—Ed.] [125] “Mechanical obstruction to the progress of labour, is sometimes produced by thus fatiguing the woman with continual walking. I have known the whole of the cellular substance lining the pelvis so much distended by oedematous tumefaction, as to make the pelvis greatly narrowed in its capacity, which repose for some hours has diminished, or entirely removed.” (Merriman’s Synopsis, p. 18. last edit.) [126] Mr. Barlow has attempted to form a synoptical table of pelvic distortion. Thus, he says, where the antero-posterior diameter of the brim is from 5 to 4 inches, delivery can be effected by the efforts of nature alone; where from 4 to 3 or 2¾ inches, delivery may take place by the efforts of nature, or assisted by the crotchet, or lever; from 2¾ to 2½ inches, it requires artificial premature delivery; from 2½ to 1½ inches, embryulcia; and from 1½ inch to the lowest possible degree of distortion, the CÆsarean operation. [127] For many of the above observations we are indebted to an admirable article upon the subject by our friend, Professor NaegelÉ, jun., in the Medicenischen Annalen, band ii. heft 2. [128] Dr. Merriman has detailed two interesting cases, which were terminated by the natural powers. In the first (p. 59,) the patient died afterwards, a small laceration having taken place in the vagina; the other appears to have arisen from an unruptured state of the hymen, which was of unusual thickness; (see Appendix II.) The case did well. [129] For much valuable information on this subject, as also for several interesting cases, we gladly refer to Facts and Cases in Obstetric Medicine, by our friend Mr. Ingleby, of Birmingham; a practical work of great value. [130] [The following very singular case of tumour of the pelvis is recorded by Professor D’Outrepont, of WÜrtzburg. A woman, twenty-six years old and well made, gave birth when twenty-five years of age to her first child without difficulty. Towards the end of her second pregnancy she again applied at the hospital in consequence of experiencing pain in the pelvic region. Vaginal examination discovered a hard and painful tumour, extending from the inner surface of the left ischium nearly to the corresponding point on the opposite side. It was hard, globular, even on its surface, and occupied the ascending ramus of the ischium and the descending ramus of the pubis, and extended over the obturator foramen. It was impossible to reach the lower segment of the uterus, or to feel any part of the child. The size and hardness of the tumour seemed to leave no chance of the birth of a living child, even by the induction of premature labour. Professor D’Outrepont, who doubted whether the tumour was fibro-cartilaginous, or a true bony exostosis, asked the opinion of many eminent men who saw the case. They did not express themselves with certainty as to its nature, and the patient refused to allow an experimental incision to be made into the tumour. A short time before labour began, the tumour was thought to have become slightly compressible. When labour commenced, the professor called a consultation in which it was determined that unless a great change had taken place in the character of the tumour, an attempt should be made to remove it, or to cut away the bone if that should be found to be implicated, and as a last resource, to perform the CÆsarean section. On an examination being made, the right foot of the child was found to present, the cord was prolapsed, and did not pulsate. The tumour, however, was found to be so much softened that it was possible to pass three fingers through the outlet of the pelvis. Professor D’Outrepont brought down the foot, in doing which, he found that the hips had compressed the tumour still more. The chief difficulty was experienced in extracting the head by means of the forceps, which gave the patient considerable pain. The child was still-born, but was speedily recovered. After the birth of the child, the tumour regained its former size, so that the placenta could not be expelled by the natural efforts, and it was necessary to introduce the hand in order to remove it. The patient recovered rapidly, and returned ten weeks after her delivery, in order to have the tumour removed, which operation was performed by Professor Textor. The growth was found to be fibro-cartilaginous, and was connected neither with the bone nor the periosteum. It weighed 11½ ounces, and was so hard that none but they who were present at the patient’s delivery, could have believed its previous softening possible. The patient was completely cured.—Ed.] [131] A sudden drink of cold fluid will generally excite contractions of the uterus, owing to the close sympathy which exists between it and the stomach. A couple of ounces, at most, will be sufficient for this purpose, if swallowed quickly; a larger quantity not only fails of its effect, by oppressing the stomach, but, by filling it with fluid, renders almost inert any stimuli or medicines which may afterwards be required. [132] “Cold injections,” says Dr. Young, “should be thrown into the uterus, and repeated ten or twelve times; as on this the success depends.” (MS. Lectures.) [133] Essay on Inversion of the Uterus. Dublin Journal for September and November, 1837, quoted by Dr. Churchill on Diseases of Females, p. 317. [134] Midwifery Hospital Reports. Med. Gazette, May 31, 1834; also Aug. 26, 1837. [135] “I have reason to believe that a placenta which is entire and uninjured, which is enclosed in the uterus, adherent to it, and shut out from access of air, never becomes putrid.” (Matthias Saxtorph, Gesamm. Schriften.) [136] [An interesting memoir on retained placenta, by Dr. Edward Warren, of Boston, will be found in the American Journal of Med. Sc. May, 1840, p. 71.—Ed.] [137] Dr. Churchill observes, “I have found, in several cases of prolapse, that the placenta was situated low down on the side of the uterus, and in some few others that the funis was inserted into the lower edge of the placenta.” (Edin. Med. and Surg. Journal, Oct., 1838.) [138] [Dr. Churchill in his Researches on Operative Midwifery, subsequently published, has collected the results of 92,017 deliveries, in which there was prolapse of the cord, in 333 cases, or 1 in every 276?.—Ed.] [139] [A figure of this instrument is given in Dewees’ Midwifery, Pl. XVIII. and the method of using it fully described.—Ed.] [140] In the edition which has been translated into English, A. D. 1612, it is the twelfth chapter. [141] We subjoin the passages to which we have referred in the three above mentioned cases:— Case 115. “I cannot implicitly accede to the opinion of roost writers in midwifery, which is, that the placenta always adheres to the fundus uteri; for in this, as well as many former instances, I have good reason to believe that it sometimes adheres to or near the os internum, and that the opening of it occasions a separation, and consequently a flooding.” Case 116. “The first thing I met with was the placenta, which I found closely adhering round the os internum of the uterus, which, among other things, is a proof that the placenta is not always fixed to the bottom of the uterus, according to the opinion of some writers in midwifery. Its adhering to the os internum was, in my opinion, the occasion of the flooding; for as the os internum was gradually dilated, the placenta at the same time was separated, from whence proceeded the effusion of blood.” Case 224. “It is generally believed that the ovum, after its impregnation and separation from the ovarium, and its passing through the tuba Fallopiana, always adheres, and is fixed, after some time, to the fundus uteri; in this case the placenta adhered, and was fixed close to and round about the cervix uteri, as I have found it in many other cases, so that upon a dilatation of the os uteri a separation has always followed, and hence a flooding naturally ensues.” [142] The second edition of Roederer’s admirable Elementa Artis ObstetriciÆ, which was published by his distinguished successor, Wrisberg, in 1766, three years after his death, is that which is chiefly known, although it never had an extensive circulation in this country. The means of communication with the Continent at that time were very different to what they are at present; and although none can regret more than ourselves that Roederer’s work should have passed unnoticed in Dr. Rigby’s Essay on Uterine HÆmorrhage, still we feel assured that the liberal portion of the medical world, whether in this or other countries, will not attribute this omission to a disingenuous suppression of his name, but rather to the more probable circumstances that, residing in a provincial town, and actively engaged in the arduous duties of an extensive country practice, Dr. Rigby had not enjoyed an opportunity of consulting the work; at any rate, we have good reasons to know that he never possessed it. [143] Not 1776, as stated by Dr. R. Lee. [144] Dr. Merriman has also recorded three cases of this kind, one of which occurred to himself; in this case “the placenta was expelled many hours before the child was born;” the mother died from puerperal fever. [145] [A very interesting account of puerperal peritonitis, as it prevailed in the Pennsylvania Hospital in 1833, is given by Professor H. L. Hodge, in the American Journal Med. Sc., for August, 1833, p. 325, et seq.—Ed.] [146] This condition of parts bore the closest analogy to the state of the cellular membrane, so constantly observed in fatal cases of phlegmonoid erysipelas, or diffuse cellular inflammation. [147] [The student may consult, with advantage, Dr. Dewees’s chapter on Phlegmasia Dolens, in his “Treatise on the Diseases of Females,” also the observations of Dr. Mann, in the “Massachusetts Medical Communications,” vol. ii., and the interesting paper, by Professor Walter Channing, in the same work, vol. v. p. 46.—Editor.] This and all associated files of various formats will be found in: Updated editions will replace the previous one--the old editions will be renamed. 1.F. 1.F.3. 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