Bleeding at the arm, scarifyed and cups at the right temple, an antispasmodic potion, and two blisters on the legs, prevented any consecutive accidents; she was perfectly well on the next day, less her sight, which was not quite reestablished.

V.

Hemorrhage-five hours after labor.-Mrs. B—

; primipara -labor seven hours-child male, weighing 7 pounds: First position of the vertex. I returned five hours after delivery and found her suffering greatly-referring all her pain to the region of the articulation of the femur with the pelvis. On inserting the finger into the vagina to ascertain the condition of the internal parts, I found a singular tumour at the top of the vagina upon the left side. It was so considerable, that I could not at first discover what it was. After having well oiled the hand, I introduced it into the vagina, and found the orifice of the womb at the top of the tumour. Having now discovered that this organ was filled with clots of blood which it could not disengage, I extracted them with the two first fingers, and the patient was immediately relieved.

VI.

Rupture of the Uterus-APRIL 17th, 1833.-Mrs. S mother of three or four children; miscarriage of 7 or eight months -male child, weighing 3 pounds. This lady was attacked with a strong uterine hemorrhage after the fatigues occasioned by moving. This hemorrhage, at once followed by pains of labor, was at first arrested or at least lessened by rest in bed, use of the acetate of lead, and acidulated rice water for drink. But after some hours the pains were renewed in such a way as to make me fear that the miscarriage would certainly take place. The head pressed strongly on the uterine orifice, already dilated an inch, and the membranes were distended.

After having waited two hours, to follow the progress of the labor I ruptured the membranes, and the uterine contractions appearing at short intervals, seemed to cause much suffering to the patient, though the head no longer pressed strongly upon the uterine orifice. Having asked her, "why she did not help her pains ?” she answered," she had not the strength, and suffered too much pain in the womb to do so." She was then taken with vom

iting, and had already thrown up twice, when all at once, without any strong contraction of the womb, without complaining more than usual-without feeling anything extraordinary-without fainting-without tinnitus aurium—without any indistinctness of vision -the head of the fœtus already in the excavation of the pelvis, and outside the orifice of the womb for a large half of its extent, was withdrawn all at once towards the superior strait.

This accident causing me to fear a rupture of the uterus, without losing a moment I put the hand into this organ, and found the entire placenta detached, and the fœtus drawing more and more upwards. At the moment of the introduction of the hand, a severe hemorrhage followed; after having withdrawn the placenta from the vulva, I sought the feet of the child, which I also withdrew without difficulty: the woman felt no more pain and only complained of weakness-but she was without pulse. Spirituous frictions upon the abdomen, cordial drinks, tonic and antispasmodic potions revived her strength a little, and her pulse returned. Her mental faculties were perfect, and she answered with precision all the questions put to her. She requested bottles of hot water to be placed at her feet, which she complained as being cold, also of cold perspiration, although her skin was dry, she was still very weak.

Obliged to leave her for a few moments, I ordered a continuation of the remedies in use until I returned, which was not long. But on my return I found that she had just breathed her last, with full consciousness, and the ability to swallow all that was offered her. I regretted much that a post mortem examination could not be made, but the natural repugnance of the friends to the operation, deprived me of this advantage.

Notwithstanding, I think there is no doubt of the rupture of the womb, though the group of symptoms which characterize this accident were not complete. I doubt not that the fœtus withdrawing so rapidly towards the abdomen, would have penetrated entirely into it if the promptness with which I operated had not prevented it.

VII.

Rupture of the Uterus-AUGUST 29th, 1836.-Called in consultation to see an unfortunate German woman, who had been in labor several days with her second child. The waters had been broken

24 hours, with a presentation of the arm up to the shoulder. The examination discovered that the womb was lacerated at its neck, and that the child was situated in its fundus, with the left arm placed on or near the head.

the

In this position it was impossible to seek the feet, or even to find arm, as the one which was out of the vulva had been disarticulated at the shoulder by a slight traction. This assured us of the decomposition of the fœtus, and that it had been dead a long time; it was necessary to remove it from its present situation, in order to extract it, which was done in half an hour. The woman supported the operation well, but died two days afterwards.

VIII.

Convulsions.—Mrs. F primipara. With the first pains of labor she was drenched with the waters of the amnios, and experienced at the same time a violent head ache, which was relieved by a bleeding of 16 ounces. The delivery was happily terminated eight hours after, but in less than three-quarters of an hour she was seized with violent convulsions and a loss of consciousness. Injections, sinapisms, vesications, a bleeding of eighteen ounces, and anti-spasmodic portions produced but little effect. Twelve hours after she had not yet recovered consciousness, and was again seized with convulsions A bleeding of eight ounces, purgative powders which produced several evacuations in the course of the morning, without apparent improvement, cups to the temples which yielded twelve ounces of blood, chicken broth, barley water with sweet spirits of nitre, and musk potions in the dose of three grains to the hour were employed. Her consciousness returned after having taken a scruple, and after the lapse of forty-eight hours. The patient had no recollection of having been confined, though she was perfectly herself during labor, and even three-quarters of an hour after delivery. The night of the third day offers again some disorder of the brain; opium, added to the musk potion, produced calm. The fourth day passed without any new symptoms; again one slight attack from the fifth to the sixth day-great weakness. Infusion of quinia and columbo were administered and the patient commenced to improve on the seventh day. This improvement continuing through the succeeding days, she had perfectly recovered at the end of the month.

IX.

Convulsions-JANUARY 25th, 1840.-Mrs. McC

-, primipara. Arrived at the seventh month of her pregnancy, she experienced much uneasiness in the head during two successive days. But the physician was only sent for after she was seized with a violent convulsion. The physician bled her immediately, but without success, which forced him to have recourse to a second copious bleeding, after several more convulsions, and to apply sinapisms to the legs. The woman not improving, several hours after, I was called in. I found her without consciousness, the limbs rigid and the pulse strong and frequent. Seven or eight cups were applied to the temples, the head was shaved and covered with a large blister, and the sinapisms to the legs renewed. At the visit the next morning we found her condition much the same. The woman having again had convulsions during the night, a third bleeding at the arm was ordered, and the infusion of valerian to be taken by the spoonful with a few drops of assafoetida. The labor was declared during the course of the day, and the woman was delivered about 6 P. M., of a male child, dead, and the same time a copious fecal discharge. She then pronounced some words very distinctly but immediately sank again into coma, and had another strong convulsion during the night. At my visit this morning (27th,) she was still without consciousness-her pulse was pretty good, much less frequent, and gave us some hope of recovery. All species of remedy seeming to us useless, we agreed to maintain her strength by the moderate use of Madeira wine added to water gruel, to be taken by table-spoonfuls. This woman expired in a convulsion, which came on 24 hours after delivery.

X.

Labor and Death-JANUARY 12th, 1818.-Mrs. L -, mother of several children, aged 34 or 35 years, was happily delivered of a male child, after 12 hours of labor. Notwithstanding, she seemed weak and exhausted after the delivery, and had several faintings without apparent cause. The bandage applied around the abdomen, the use of vinegar, restoratives of all kinds, externally and internally, could not prevent her death, which took place three hours after the extraction of the placenta. If the uterus had not

perfectly contracted, if there had been the least sign of internal hemorrhage, or any distension of the abdomen, I should have attributed the exhaustion and the faintings to an internal hemorrhage; but nothing could have caused one to suspect it, and it certainly did not take place. This death must then be attributed to a want of reaction of the system-or in other words, to a general collapse.

XI.

of a

Labor complicated with Rheumatism.-Madam C delicate constitution, and very sensitive to pain, arrived at the 8th month of her pregnancy. Having imprudently exposed herself to a cold and damp atmosphere, she was immediately seized with rheumatic pains, which at first affected the womb, and caused uterine contractions which feigned during 24 hours the approaches of delivery, the uterine orifice becoming dilated half an inch. Notwithstanding this, the pains all at once left this organ, and at first attacked the right arm, then the inferior extremities, and in fine the whole body. This condition lasted five days, in spite of bleeding, friction, anodynes, &c. &c., then without known cause, the pains returned to their original seat, and the labor was certainly commenced. After three hours of excessive pain, the membranes broke; and though the pains continued during six hours more, the delivery made no progress. Attributing this delay to the brevity of the uterine contractions, I decided to administer ergot to increase them, in the dose of 3 grains every 15 minutes--the remedy seemed to be indicated by the fruitless length of the labor. The head of the fœtus having been for a long time in the pelvis, the uterine orifice was supple and sufficiently dilated.

The strength of the patient began to give way, and there certainly existed in the bottom of the uterus a tumor, very distinct from that formed by the child, of the size of the fist at least, which might have prevented the action of the womb. A scruple of powdered ergot, administered in the space of two hours, had not after three hours produced the desired effect, though the efficiency of the remedy could not be doubted. The woman discouraged, exhausted, fatigued and impatient of delivery, insisted upon my terminating the labor with the forceps. The head was in the first position, and I had no difficulty in applying the instrument, though it was