XXV.

NOVEMBER 19th, 1813.—Mrs. W

was delivered at the term of eight months, of a fœtus which had only a developement of four months-I have observed many similar cases. When the fœtus ceases to live, it can still remain in the womb up to the term of nine months, no matter at what period of the pregnancy its death occurred.

XXVI.

APRIL 21st, 1813.—Mrs. D, primipara, after a pregnancy of four months gave birth to a fœtus which had only the ordinary developement of that epoch of pregnancy. Nevertheless, she lived 29 hours, cried, passed meconium, and took sugar and water several times. The child was not weighed, but I am sure that it would not have weighed more than ten ounces.

XXVII.

MAY 22d, 1813.-Mrs. M- -, mother already of several children and a woman of strong mind and much observation, told me that she felt convinced the child she was then carrying had ceased to live—and asked me at the same time, if I thought there would be any evil consequences resulting from it. I assured her not, and told her that, notwithstanding her assertion, the fact seemed to me very questionable. I was sent for at the end of the nine months, and delivered her of a fœtus of the developement of four months and a half-well preserved (bien conserve,) and also the placenta, which was easily expelled. The delivery was perfectly dry, and there was no discharge whatever.

XXVIII.

JUNE 22d, 1813.-Mrs. W- at the period of five months and a half of her pregnancy, was seized with pains like those of her previous confinement, and lost a great quantity of water; notwithstanding, the pains ceased, and the loss of water also, and she arrived in pregnancy at the nine months. The labor at this period lasted more than twelve hours A bleeding at the arm, intended to relieve the pains which had become insupportable, terminated the delivery, in less than fifteen minutes, of a large and healthy child.

Another case, equally rare but of a different kind, took place in another woman at the same period of her pregnancy-instead of a loss of water it was a torrent of blood. The quantity was very great, and finding that the loss of blood was arrested, and firmly persuaded that the miscarriage had taken place, I left the woman without making any investigation, relying on the report of the nurse. I was sent for at the full term of nine months, to remedy an unknown difficulty in the same woman; I found that the membranes were so thick and strong that it was impossible for the head of the child to make its way through; but after having incised them, the womb disburdened itself of a large boy full of life.

XXIX.

Case of Female Twins.-DECEMBER 24th, 1841.-Mrs. D 4th labor. The midwife who delivered this woman of a twin at about six o'clock in the morning, sent for me two hours after.

I found the arm of a second child outside of the vulva; the head rested in the right iliac fossa (fosse iliaque,) and the feet towards the fundus of the womb, which was elevated in the left hypochondrium. I was prevented from reaching up to the neck by a strong projection of the sacral vertebra, which left but little space. at the superior strait of the pelvis on the left side. Having removed the right hand, I introduced the left, in order to draw down the head into the cavity of the pelvis, which is very large-but I was again disappointed; I then had recourse to the blunt crochet (crochet mousse). The child was extracted breathing feebly, and having a wound at the inferior part of the neck a little above the clavicle-it died soon after its birth. Making the section of the cord I found that the circulation of the blood no longer existed, so that the child could not have lived a few minutes longer in the uterus, if it had not been extracted so quickly.

As I did not speak the language of the midwife, I could not ascertain what she had done during the two hours which elapsed after the birth of the first child. Perhaps she had drawn the arm of the child out of the vulva and thus rendered the position more difficult.

I have learned since that the midwife who perfectly understood the position of the child, tried to reach the feet, without being able.

to do so, and only sent for me after having despaired of success. Moreover it seems that she had several times turned a child in a similar position, which leads me to think, that the means I employed were the only suitable ones for the safety of the mother, though the vectis would have been less dangerous for the child, applied on the head, than the blunt crochet on the neck. But I doubt if it would have succeeded, from the force which I was obliged to use to disengage that head-a resistance for which I was little prepared, considering the extreme smallness of the twin.

STATISTICS OF THE PLACENTA.

The cases following are the most of those in which any peculiarity of the placenta or cord presented themselves, and being translated in full, will supercede the necessity for a special collection in statistical form :

Of the 1,787 women, there were seven cases of placenta prærvia, or one in every 255.3 cases. These have been already mentioned under the "presentations.”

In seventeen instances, or one in every 17.2 cases, the placenta was so adherent that the introduction of the hand was necessary for its removal.

The placenta being retained by an "hour glass contraction" of the uterus, is mentioned but in a single instance.

Of the six cases of twins there were double placentas in two; each with its membranes and umbilical cord.

One case of inversion of the uterus, which was reduced in the usual manner, after which the woman recovered.

CASES RELATING TO THE PLACENTA AND CORD.

A young accoucheur is sometimes very much alarmed in observing a swelling of the womb, some time after the delivery of the placenta. His fear is, that there is an accumulation (épanchement,) of blood in the cavity of that organ-but this fear is without foundation. In this case there is no extravasation; the blood which occasions the swelling is contained in the parieties of that organ, and will be expelled by the contractions which soon take place, and which are the cause of those often insupportable sufferings called after pains.

8

M

XXX.

Cord four times round the neck.-SEPT. 2d, 1830.—Mrs

mother of several children-child male, weighing seven pounds, born dead with the cord four times round its neck-1st position of the vertex.

XXXI.

4th

MAY 19th, 1833.-Cord 56 inches long.-Mrs. M labor of 6 hours—preceded by a copious hemorrhage, which was arrested by bleeding at the arm-child male, weighing 8 pounds1st position of the vertex. The umbilical cord was 56 inches long, and after surrounding the body of the child in such a way as to confine the arms to the body, it extended to the neck and encircled it five times.

XXXII.

Shortness of Cord.—Mrs. T— 8th labor of 7 hours-male child, weighing 8 pounds-1st position of the vertex. I was obliged to cut the cord, which surrounded the neck twice, and was so strongly tightened that I could not disengage it otherwise.

Mrs. H

XXXIII.

4th labor of some hours-large boy-1st position of the vertex. The cord was so tight around the neck that I was obliged to sever it.

XXXIV.

Shortness of Cord.-Mrs. Mc T————————, labor of 7 hours—male child, weighing 9 pounds-1st position of the vertex. The cord was scarce fifteen inches long, and was reduced half its length by the turns which it formed on the neck of the child, making its expulsion very difficult and nearly occasioning its death; nevertheless I terminated the accouchment without making the section, which was indicated, but which might have proved fatal if the expulsive force of the uterus had been retarded or stopped.

XXXV.

Adherent Placenta.-Two of my colleagues requested me to see a woman, delivered since 18 hours, whose placenta adhered to the womb in nearly its whole extent and could not be extrica

ted. Examination proved the truth of the fact stated, and also a contraction of the uterine orifice so rigid, that with difficulty one finger could be inserted into the cavity of that organ. In the space of half an hour at most, I succeeded in occasioning the dilatation, and in detaching the placenta entirely. I am aware that in similar cases, many distinguished authors would have waited the action of nature. But I cannot agree with them, and until the present time, experience has proved to me very often that my way of acting and thinking is most favorable to the patient.

XXXVI.

Retained Placenta.-Mrs. John R, 3d birth—a female, weighing 8 pounds-1st position of the vertex-labor slow, except towards the end, when the womb contracted forcibly and expelled the child. After its birth, the uterine orifice, as well as the body of the womb, contracted so forcibly that it was impossible to effect the extraction of the placenta. I thought, after waiting in vain for the cessation of the spasm, it was better to dilate the uterine orifice with the index finger, and draw the placenta outwards, by traction upon the cord, than wait longer-thus exposing the patient to some hemorrhage, or at least leave her in mortal anxiety concerning her condition.

The operation succeeded to my wishes, and proved, for probably the twentieth time, that boldness and “savoir faire” are not inefficient in such cases.

XXXVII.

H

DECEMBER 22d, 1838.-I was sent for in consultation, for Mrs. whom I delivered of a very large placenta, after 15 days of suffering. She thought herself in her third month of pregnancy, but I could discover no fœtal conception.

XXXVIII.

Case of Hour-glass Contraction.-Mrs. C

in labor 12

hours with her fourth child-a female weighing 8 pounds-1st