Proceedings and Reports of the Medical and Chirurgical Faculty of the State of Maryland

position of the vertex. The womb contracted in the middle of its body, forming the hour-glass shape, so that one-third of the placenta was retained above the artificial orifice. This condition compelled the introduction of the hand into the womb, in order to dilate this orifice with two fingers, and to extract the placenta.

XXXIX.

Case of Twins-Two Placentas.-SEPTEMBER 11th, 1830.Mrs. S 9th labor-case of female twins, with two distinct placentas. The two children weighed 11 pounds; there were two pounds difference between them-the first born was the stronger. I was obliged to introduce the hand into the womb to deliver the second, which was placed transversly. The membrane. was so strong, that not being able to break it by pressure with the finger during the uterine contractions, I was obliged to incise it. It was with some difficulty that I seized the right foot, with which I terminated the delivery.

XL.

Twins-MARCH 26th, 1834.-Mrs. C, 5th labor, of some hours-male twins. The first presented in the 1st position of the vertex, the second by the feet. The elder weighed 8 pounds, the younger 7 pounds; the latter died an hour and a half after its birth. The two placentas weighed from 5 to 6 pounds-so that the whole burden (fardeau) was 21 pounds. The woman lost more than sixty ounces of blood.

XLI.

Twins Two Placentas.-FEBRUARY 18th, 1844.-To-day, at 7 o'clock, P. M., I was called to see a colored woman, who had been delivered of a small child, between 10 and 11, A. M. The midwife who attended her, tired of holding the cord, deserted, saying that the placenta adhered. An examination discovered the presence of a second child, which I extracted by seeking the feet. I left the woman in good condition, and the twins alive-a boy and a girl. There were two placentas, each with its membranes and an umbilical cord.

XLII.

Placenta Prævia.-Mrs. T. H

mother of several chil

dren, when taken with labor pains, was attacked with very considerable uterine hemorrhage. The physician and midwife called left. her in that state nearly 24 hours, when I was summoned. An examination showed me a presentation of the placenta, detached in almost its entire extent. The woman was without pulse for several hours, and might be said to be dying. Nevertheless, as her death was certain unless relieved by birth, after having broken the waters, I went to seek the feet, which I pulled out of the vulva one after the other. The body followed the traction, up to the shoulders, which I could not extract without disengaging or detaching the arms by means of the crochet.

The head being very large, and the pelvis a little disproportioned. I was obliged to implant the pointed crotchet into the orbit to make it descend. The mother, already exhausted, died a quarter of an hour after the operation, which was terminated in less than half an hour. A female child, weighing nearly 9 pounds.

XLIII.

Placenta Prævia.-Mrs. C4th birth. This lady had obtained the term of seven months, when, without apparent cause, she was seized with uterine hemorrhage, which alarmed her accoucheur and determined him to require my services. Four hours after the accident, I found on examination that a part of the placenta was detached-the uterine orifice was very pliant and dilated, though the woman felt no pain. After friction with the finger on that orifice for half an hour, I broke the water sac; the pains came on gradually, and the birth a short time after. The child, a girlweighed about 43 pounds, presented in the last position of the vertex, and living though very feeble.

XLIV.

Placenta Prævia-MARCH 31st, 1829.-Mrs D

mother

of a numerous family, in the eighth month of pregnancy was attacked with a uterine hemorrhage, after a long drive. Rest, lemon

ade, acetate of lead, elixir of vitriol, and bleeding from the arm, only moderated it during three weeks. At last the premature pains of labor came on, and continued, though feebly, for two days. The touch showed a presentation of the placenta over the uterine orifice already largely dilated. The hemorrhage was evidently caused by the detachment of a portion of the placenta, and it was to be feared that it would weaken the mother by its continuance, without preventing the death of the child, already nearly certain. In accordance with this opinion I decided to administer ergot, to accelerate the delivery, as recommended by Hallcombe. But in one hour, not having produced the desired effect, I passed the left hand between the uterus and the detached portion of the placenta, in order to rupture the membranes and to seize the feet; I found the child rolled upon itself, and felt at the same time the face, an arm, and a knee. It was easy for me to remove the right foot from the vulva, and drawing it gently, to seize the other. The body soon followed without effort, and the labor was terminated in a few moments. The child was born dead, and the mother recovered entirely.

Does not this accident of delivery, often fatal to mother and child, proceed from the hesitation of the physician, the too great confidence in the remedies he employs, and the hope that time will produce sufficient uterine contractions to effect the expulsion of the fœtus before the hemorrhage becomes fatal? This conduct seems to me blameable whenever the hemorrhage is great; when the uterine orifice becomes somewhat dilated, and there are signs of labor, whether at term or not, I do not hesitate to attempt the dilatation of the orifice; rupturing the membranes, and seeking the feet of the fœtus-unless the head presents in a good position and is strongly pressed out by vigorous contractions of the uterus. In this case there is no more hemorrhage, and the delivery is terminated by the force of nature. It would, under these circumstances, be imprudent and unreasonable to interfere.

This manner of acting has always succeeded with me, in the many cases I have met with in the course of my practice. I have only seen accidents in those cases too long abandoned to nature -almost always here incapable of helping herself.

In concluding this report, we would suggest to the members of the society who wish to keep a record of their obstetrical practice

the feasibility of doing so, with the sacrifice of but little time, trouble, or expense, by means of the ruled table here presented, or one more complete offered by Dr. Medcalf in the American Journal of Medical Sciences for October, 1847, page 311.

In order to abridge the labor, which was considerable, of analyzing the cases recorded by Dr. Chatard, we had large quarto paper thus ruled by Mr. James S. Waters, (at but small cost,) which could very conveniently be bound in covers, and would preserve the more interesting points of a large obstetrical practice in a constantly available form, we did not have as many lines ruled as Dr. Medcalf's table presents, because the records before us would in no instance fill them entirely.