four cases in which women, when extremely prostrated, have died from the shock of turning.—Dublin Quarterly Journal, August, 1853, p. 240.

129.-On a New Method of Inducing Premature Delivery. By SCANZONI.-The author was induced, by observing the active sympathy between the breasts and the other parts of the sexual apparatus, to try to produce premature delivery by irritating the nerves of the mammary glands. The first experiment was made upon a young woman, aged 24, who, two years ago, had been delivered by perforation, in consequence of contraction of the pelvis. In the thirty-second week of utero gestation, apparatus constructed of caoutchouc, forming sucking pumps, were put upon the nipples. During three days they were used about seven times, the process going on upon each occasion for two hours. After the third application, the neck of the uterus became shortened; after the sixth, severe labour pains came on; after the seventh, the child was born.

The only danger likely to ensue from this very simple method of treatment is inflammation of the mamma; this can be met with proper treatment.

A second case, of a similar kind, occurred to the author. A young woman, enceinte for the first time, suffered so severely from dyspnoea, connected with organic disease of the chest, that premature delivery was necessary for the preservation of her life. After the third application of the sucking-pumps, an apparently dead child was born; respiration, however, was soon re-established. The author remarks, that this case is not quite conclusive, because premature delivery occurs often in connexion with severe dyspnoea, independent of other influences.-Ges. zu Würtzburg.

130. A CASE OF TRIPLETS.

By R. C. SHETTLE, Esq.,

[We may notice in this case, first, the extreme exhaustion of the patient at an early period, without any apparent cause; and secondly, the absence of hemorrhage. Mr. Shettle says:]

At four o'clock in the morning of the 30th July last I was summoned to attend Mrs. C., aged twenty-four, who was in labour with her first child. On reaching the house the nurse informed me that Mrs. C. had been in slight pain during the whole of the preceding day, but that labour pains had not come on until three o'clock, when they sent for me.

Upon making an examination, I found the os uteri about one-third dilated, the vertex presenting, and the membranes (during pain) protruding slightly through the The pains, which had not been severe or long continued, now gradually increased in severity, and came on about every ten minutes; indeed all seemed progressing favourably, and I fancied labour would terminate in three or four hours. About six o'clock the membranes (which were quite thin) ruptured: the os uteri becoming fully dilated by eight o'clock, the head pressed down upon the perineum, in which there was an absence of all rigidity. Labour pains after this time began to flag, and my patient exhibited other signs of exhaustion; the pulse becoming quick and irritable; the tongue dry, brown, and coated. Although it was a first labour, there being an absence of all rigidity in the external parts, I administered a dose of the volatile tincture of secale in a little brandy-and-water, in the hope that labour pains might be again brought on, but without effect. By one o'clock the pains had entirely ceased, and she became very irritable, with pulse 120. I therefore considered it proper to have recourse to the forceps, with which I delivered her of a girl at twenty minutes past one P.M. Finding the uterus contained a second child, I once more administered stimulants, in the hope of inducing natural labour pains, especially as the womb had been partially emptied of its contents; but I was again doomed to be disappointed. After waiting an hour, I introduced my hand, ruptured the second bag of membranes, and brought down the feet of the child, which I delivered immediately. Finding yet another, I again introduced my hand; but as the head was the most dependent, I had to turn, which was soon effected, and the

child delivered with but little suffering to the mother. A bandage had been applied round the abdomen before the birth of the first child, and had been tightened when necessary; but during the delivery of the three infants (girls) there had been no pain, and consequently no contraction of the womb. The after-births (three united) were not thrown off by the natural process from the surface of the uterus, and I considered it would be better to remove them at once than to delay doing so, as she would then have to be disturbed again for the purpose of introducing my hand for the third time. I separated the placenta with the nails, and by grasping the womb externally with the other hand, induced contraction of that organ, and brought them away, without any hemorrhage, by three o'clock. I immediately gave a stimulant, and made the bandage round the abdomen as tight as possible. The uterus contracted firmly, and showed no disposition to re-dilate. I then ordered that she should be kept as quiet as possible, hoping she would get some refreshing sleep, while I retired to an adjoining room, desiring to be summoned should any untoward symptom present itself. After the lapse of an hour I was informed that she was not quite so well, and had not obtained any sleep. I found her very restless, complaining of dimness of sight, and she had lost the use of one side. I administered brandy, ether, and ammonia at intervals, and at six o'clock she appeared more rational and quiet, dozing occasionally until after eight o'clock, when she awoke with jactitation and all the signs of approaching death, and expired six hours after the termination of labour, entirely, to all appearance, from nervous exhaustion. The children are living and at this time doing well.-Lancet, Oct. 1, 1853, p. 316.

131.-CASE OF TURNING INSTEAD OF CRANIOTOMY, IN A CONTRACTED PELVIS.

By JOHN TRAILL, Esq., Arbroath.

[The patient, in this case, Mrs. R., was first confined in May, 1836. After two days' tedious labour, during which tartar emetic and blood-letting were employed, violent convulsions came on, and the child was delivered with the forceps. Her recovery was protracted. In 1838, she was again delivered by the forceps; violent convulsion having again supervened. The recovery in this case was so extremely slow, and the health so seriously affected, that Mr. Traill determined, in case of future pregnancy, to recommend the induction of premature labour. He proceeds:] Some months ago, Mrs. R., in her forty-third year, informed me that she was again pregnant, and that she expected to be confined about the end of May.

Having carefully studied Professor Simpson's papers on 'Turning as a substitute for Craniotomy,' and believing it to be a favourable and proper case for the plan proposed, I decided on allowing labour to go on to the full time.

May 19. This morning I was called to Mrs. R., and was greatly annoyed to find her in a most unfavourable state. The membranes had given way six days previously, and the liquor amnii had since been constantly dribbling off; moreover, she had had smart labour-pains for thirty-six hours, and was in a complete state of mental prostration and hopelessness as to the result, both to herself and the infantso much so, that the child's dead clothes were provided, and she protested against my being sent for, declaring that she had no chance of being delivered for days to come. On examination, I found the head firmly impacted at the brim of the pelvis, but only a small part within reach of the finger elongated, and the scalp swollen; the os uteri, about the size of a crown piece, not acted upon by the pains but quite dilatable; the contraction at the brim of the pelvis was greater than I had calculated on-the sacro-pubic diameter did not appear to me to exceed three inches.

Having decided on still attempting to turn, I gave chloroform to the full extent, and then with some difficulty succeeded in pushing up the head and passing the hand into the uterus. I found the liquor amnii almost entirely evacuated, and the uterus closely enfolding the infant; the pulsation in the cord was weak; and while searching for a foot, the child had repeated convulsive movements. This induced me to hurry the operation as much as possible, but I found considerable difficulty in bringing the head through the brim, so that fully half an hour elapsed before delivery could be completed. The child, a male rather under the average size, was quite still for several minutes, but ultimately recovered.

When the mother awoke from her sleep and heard the cries of her infant, she would not be convinced but that we were deceiving her, both as to her own delivery and as to the possibility of having given birth to a living child. She has made a rapid and excellent recovery without one untoward symptom, and now, in better health than she has enjoyed for eighteen years, is suckling her child, a strong healthy boy.

The gratifying result of this case has very strongly impressed on my mind the soundness of the principles on which Professor Simpson has advocated his proposals as to the practice of turning in contracted pelvis, and has led me to believe that the facility afforded to the advance of the head through the brim of the pelvis in consequence of its changed position, and of the traction which we are enabled to exert through the extruded body of the child, is much greater than could at first view be considered possible.

If I had been aware of the degree of contraction existing, I do not think I would have ventured to have allowed labour to go on to the full period. The head was of average size, or very nearly so-the sacro-pubic diameter, I am certain, did not exceed three inches (I believe it to have been considerably less); but be that as it may, I found the head firmly wedged, and yet only just entered within the brim, after thirty-six hours of continued smart uterine action, whilst the state of the child's circulation and nervous system, as ascertained by the hand in utero, showed that is life could not have been much longer protracted.

I cannot therefore doubt, that by the practice pursued, the life of the child was saved; nor do I think that the benefits resulting to the mother can be considered less important.

From the degree of deformity of the pelvis, the firm impaction of the head, and its non-advancement-notwithstanding the prolonged uterine action-I do not believe that delivery by the long forceps would have been possible. I believe that craniotomy must ultimately have been resorted to; followed as in the two previous labours-which occurred under circumstances in every way more favourable-by al best a tedious, protracted, and imperfect recovery.-Monthly Journal of Medical Science, August, 1853, p. 182.

132.-Puerperal Convulsions in a Primipara delivered of Twins; Advantages of Chloroform in such cases. By HENRY RUDGE, Esq.-[The advantages of this invaluable agent will be exemplified in the following case:- -Mrs. E. M., aged twentythree, began in labour at eleven o'clock p.m., on the 25th of July. Labour progressed slowly. Previous to the arrival of Mr. Rudge's assistant, Mr. Boyce, she had two or three convulsions. At half-past five a.m., after falling asleep, very violent convulsions occurred. At nine p.m., they recurred with greater violence. Mr. Rudge soon after arrived. He says:]

On examination, I found the os uteri dilated, and the head presenting. The pains were entirely arrested; and the patient was in strong convulsions, attended with considerable hemorrhage. Under these circumstances, I quickly procured some chloroform, twenty drops of which were administered at intervals, by means of a folded cambric handkerchief, by my assistant. The effects were magical. The convulsions, after a few inhalations, entirely ceased; and I proceeded to extract the child, which was effected without difficulty. On examination, I found it was a twin case (both females); and a second head presenting, I ruptured the membranes, and extracted the second child without difficulty, with the forceps; and, in consequence of smart hemorrhage, after a few minutes, I introduced my hand, and carefully extracted the placenta. Leeches and cold applications were applied to the head. After delivery she had, at 3 p.m., one attack of convulsions. She passed a good night; the bowels having been well cleared out. No unpleasant symptom has arisen up to this date.

Mrs. E. M. was not conscious of her delivery; and was much surprised when informed that she had given birth to twins. Both infants are well, and likely to live. I have no hesitation in attributing the favourable issue of this case to the use of chloroform; and I firmly believe that, in skilful hands, it will prove an inestimable boon to the fairest portion of the creation, relieving them from much of the danger and dreadful suffering of tedious and complicated labours-sufferings, the witnessing

of which frequently unnerves the strongest of the other sex.-Association Medical Journal, Aug. 12, 1853, p. 706.

133.-CASE OF INVERSION OF THE UTERUS AFTER PARTURITION, PROVING FATAL IN EIGHTEEN MONTHS.

By JOHN GREGORY FORBES, Esq.

[Mrs. A. B., aged 25, was confined of her first child on the 23rd of April, 1850. Her health had been previously good, but from the consequences of her labour she came to town to consult Dr. Lee, in December of the same year. It was there Mr. Forbes saw the case. He describes it as one presenting all the symptoms of intense anæmia at an advanced stage. Since her confinement she had suffered from a bearing down and profuse hemorrhage, having had five attacks of the latter since July.]

On the 4th of December Dr. Lee made a digital examination, and detected a tumour projecting through the os uteri into the vagina for upwards of two inches. It was of a somewhat pyramidal shape, and its base, measuring in its transverse diameter about an inch and a half, was embraced, though not constricted, by the os, and seemed to be so intimately connected with it at all points of its circumference, that no neck could be traced. Its surface was perfectly smooth, and its consistence rather softer than that of the common uterine polypus. Some trifling hemorrhage followed the examination. Dr. Lee expressed his conviction that the case was one of inverted uterus, and advised strict rest in the recumbent posture till after the next catamenial period, then near at hand, with the employment of cold lotions and ice, if neces sary, to restrain the hemorrhage. The result of this examination led to a communication with Dr. Prothero, the lady's medical attendant in the country, who kindly transmitted to me the following particulars of her labour, and the history of the case while under his care:-The labour proceeded well under natural presentation for fourteen hours, when the pains nearly left her. The os uteri being fully dilated and yielding, a dose of ergot was given and repeated in an hour. This had its full effect, and in about two hours the head had descended into the pelvis; but the case now became complicated by a loop of the funis slipping down in advance of it. With the view of saving the life of the child, the forceps, as soon as they could be procured, were applied, but though the delivery was easily effected, it was dead. The placenta was expelled in a few minutes, no traction being necessary, and the uterus contracted well. The funis was of natural length. After the lapse of an hour some hemorrhage took place, and the patient became very faint; but a medical gen tleman then in charge of her stated, that before he left her all bleeding had ceased, that the uterus was firmly contracted, and that everything was right. She passed a comfortable night, and for the next three days all went on satisfactorily. The bowels were moved on the third day by medicine; but a few days afterwards Mrs. A. B. stated that the action was attended with much straining and pain, and that she felt as if something had come down with the motion, but that it gave her no great inconvenience. On vaginal examination, it was now discovered that the uterus was inverted, the fundus having descended to within an inch or two of the labia; but no unusual discharge or hemorrhage had taken place since the day of delivery. An attempt was at once made to reduce it with as much force as was considered justifiable, which unfortunately proved ineffectual; and on the following morning a consultation was held, when perfect rest and the use of astringent lotions were recommended. Up to the 8th of May (after which date an examination was not permitted for upwards of three months) no alteration had taken place in the condition of the parts; a suspensory bandage was therefore made with a cushion to support the uterus, and in time the patient was able to take gentle carriage exercise.

A slight sanguineous discharge existed up to the 12th of July, which, though varying more or less in quantity, did not occur to any alarming extent. On this day very profuse hemorrhage took place, and produced much exhaustion, but under rest and the astringent lotions it soon subsided. In the middle of September Mrs. A. B. removed to the sea-side, and the change was attended with considerable benefit to her general health.

On the 6th December the catamenia appeared, and the discharge continued moderately for some days; but on the evening of the 12th, after a day disturbed by hys

terical feelings, a serous fluid was poured out so profusely as to soak through six or seven napkins used together. On the 13th the discharge was less and of deeper colour, and several clots of blood were expelled. The bowels had been relieved by rhubard and colocynth, but the action exhausted her much. On the 15th she suffered from feverishness and vomiting, though there was no abdominal tenderness, and in the evening had a prolonged fit of hysteria. On the 16th, after taking some blue pill and Epsom salts, a very offensive motion was passed, and during the action of the bowels she completely fainted. On the 17th the case appeared so alarming as to lead to the belief that it would be necessary to apply a ligature around the base of the tumour with the view of dividing it, which, notwithstanding the risk attending such a proceeding, seemed to be the only means of restraining the hemorrhage and of preserving the patient's life.

On the 18th, Dr. Locock saw her in consultation, and after carefully examining the tumour, fully concurred in the diagnosis previously given. The propriety of the immediate application of a ligature was discussed, but the hazardous nature of the operation being considered, and the hemorrhage being now restrained by the aid of a sponge soaked in a strong solution of alum, it was resolved to defer it. In the mean time the plan of treatment agreed upon was to surround the tumour with strips of lint dipped in the solution of alum, to support the system with nourishing diet, and to give one of the mineral acids as a tonic.

On the following day there was some improvement, a tranquil night had been passed, the bowels had been moved by Epsom salts, and there was neither faintness nor hemorrhage. The same treatment was continued till the 26th, when, as there was only a slight mucous discharge, the lint was not as usual replaced. The patient was on the sofa in the drawing room for several hours in the afternoon, and had taken throughout the day more nourishment.

During the frequent examinations which were necessarily restored to, pressure was made upon the tumour with the hope, if possible, of re-inverting the uterus; but it invariably produced such severe cutting pain in the abdomen above the pubes, that a more systematic and longer-continued attempt to effect this was precluded. The tumour itself possessed but little sensibility.

On the 1st of January, 1851, some citrate of iron in small doses was administered, but the stomach rejected it.

From this time up to the 19th, the patient, still strictly confined to the horizontal posture, gained strength. The appetite improved, and the bowels were freed at intervals by Epsom salts. On this day the catamenial period again commenced; and on the 21st the profuse sero-sanguineous discharge recurred, and with it the rapid, feeble pulse, whizzing sensations in the head, and other distressing symptoms. In the evening, during the action of the bowels, several florid clots of blood were expelled from the vagina. A mixture composed of the infusion of cusparia, tincture of catechu, and laudanum was prescribed. On the 23rd, the discharge was still more copious, and in the evening the pulse ran up to 120, with an irritable beat, the patient became hysterical, and vomited some undigested food. The tumour was, therefore, closely enveloped as before with the lint and alum, care being taken, whenever it was removed, to syringe the parts with tepid water, to bring away any clots which, at times, became very offensive. The two succeeding monthly periods, which commenced respectively on the 21st Feb. and the 29th March, were attended with precisely the same symptoms, and the same plan of treatment was adopted. During the intervals the patient rallied surprisingly, and, though suffering much at times from flatulence, intestinal pains, constipation, occasional vomiting, and other symptoms of feeble digestive power, upon the whole she gained strength, and was able to take gentle exercise in an easy carriage or an invalid chair.

On the 16th of April she was well enough to be removed to a distance of upwards of a hundred miles into the country; and though I had no opportunity of seeing her again, I received from time to time very distinct reports of her state. The catamenia returned early in May, and continued longer than usual, for I was informed, in a letter dated the 20th, that at times the discharge was still very copious, with a good deal of colour.

The succeeding period, which commenced early in July, appears to have been attended with a more severe train of symptoms than any she had before experienced. The loss of blood was most profuse for some days, and then subsided, leaving a