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rated, while its middle, cellular, and fascial tissues are comparatively entire, or at least not so deeply and extensively injured.

Fifthly, The proper management and support of the perineum no doubt modifies and diminishes this form of perineal lesion, but it fails far more frequently than is generally supposed, in entirely preventing it.

Sixthly, The evidence of the frequency of fissuring of the os and lower or vaginal portion of the cervix uteri is the same in character, and consists principally -1. In the frequency with which slight laceration of the edges of the os, and of the mucous and middle coat of the cervix, is detected in autopsies after natural labours, and particularly with first children; and, 2. In the permanent marks of its previous occurrence, as exhibited in those cicatrices and irregularities of the cervix uteri, which anatomists have long empirically, but correctly, laid down as proofs that they, in whose bodies they are found, have been previously mothers.

Seventhly, Fissures and lacerations of the vaginal portion of the cervix uteri not unfrequently occur to a very considerable extent in cases in which the tissues of the cervix have been rendered rigid by previous inflammation, by carcinoma, or by other morbid causes; and in such cases this fissuring or laceration, if limited to the lower or vaginal portion of the cervix, seems to be accompanied with little or no danger.

MEETING III.-February 26, 1851.-DR GRAHAM WEIR in the Chair.

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Dr Keiller read the following case to the Society:

Eliza Quirk, æt. 24, the wife of a soldier, was admitted into the Edinburgh Maternity Hospital, May 27th, 1850, being in the ninth month of her first pregnancy. When interrogated, she stated that for some time past she had been in delicate health, and on examination her legs were found to be slightly swollen, in consequence of which her urine was tested three times within ten days, without any albumen being detected.

Labour commenced about three o'clock a.m., of June 11th; the pains were at first trifling and irregular, and when examination per vaginam was made at ten o'clock in the morning, the os uteri was found of the size of a sixpence. The labour progressed slowly, the pains becoming more regular, and about halfpast three in the afternoon of the same day, the first stage was completed without any unusual symptom. About four p.m., the head had fairly entered the pelvis, and changed from the third to the second position. All at once, the patient turned half over in bed, and became convulsed, with the face much congested, and the eyelids twitching. In about half a minute the convulsion ceased, and the breathing became stertorous, with the eyes staring, the patient remaining unconscious.

A vein was opened in the arm, but before six ounces of blood had been abstracted, the congestion of the face disappeared, the breathing became natural, and the patient burst into tears. The arm was then tied up, and on cold water being dashed in her face, she became conscious, and inquired if the labour would soon be over. In about twenty minutes from the first attack, she had another in which the face was not changed in colour; the body and extremities were in violent motion, the chest heaved, and she cried and sobbed very much. This paroxysm was soon subdued by dashing cold water liberally on the face and chest. During this time the labour went on favourably, and the case appearing to be hysterical, and accompanied with much nervous irritability, chloroform was administered, and the patient was kept under its influence until delivery, which took place in about four hours, during which time she had six or seven attacks of a character similar to the second, but apparently much softened by the chloroform. The child—a male-was expelled a little after nine o'clock in the evening, in a state of asphyxia; but after the ordinary means had been employed for half an hour, it began to cry.

NEW SERIES.-NO. XVII. MAY 1851.

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The chloroform being withdrawn on the birth of the child, the patient continued quiet, breathing naturally. The uterus contracted well, and the placenta came away in about a quarter of an hour. For an hour after this the patient appeared to be enjoying a comfortable sleep; but about half-past ten, she was again seized with violent convulsions, with pale face, eyes staring and prominent, eyelids twitching, mouth drawn to one side, lips slightly darker than natural, tongue protruded and covered with bloody froth, breathing stertorous, chest heaving very much, thumbs bent on the palms of the hands, and grasped by the fingers. Immediately after the paroxysm-the pulse being 130, small and oppressed-she was bled to about twenty ounces, two drops of croton oil were placed on the back of the tongue, mustard poultices applied to the lower limbs and between the shoulders, bottles of hot water to the feet, and cold lotions to the head. After the bleeding, the pulse fell to 112 and became fuller, the breathing continued stertorous, and the patient remained insensible, with dilated and fixed pupils.

From this time until two o'clock in the morning of the 12th, there were four or five fits, similar to the last in character but less severe; the bowels were well moved by the croton oil, and she had passed water very freely.

At two o'clock there was another fit, in which the face was livid and frightfully distorted, the lips purple, the breathing still stertorous, and the pulse very quick and feeble. On this, twelve leeches were put to the temples, the mustard cataplasms were repeated, and cloths dipped in hot turpentine applied over the chest. The convulsions returned at intervals of about three quarters of an hour, until seven o'clock in the morning, when the last occurred, and left her very weak, with fluttering pulse; dyspnoea supervened, owing to the accumulation of mucus in the bronchial tubes, and as the patient appeared to be in a sinking state, with the upper as well as the lower limbs slightly swollen and cold, small frequent doses of ammonia were administered.

The patient never having been conscious during the intervals from the time of the first fit after the labour, and still continuing in the same state, a blister was applied about nine o'clock in the morning, over the whole of the front part of the scalp; and as the pulse had become fuller, firmer, and slower since the exhibition of stimulants, a table spoonful of brandy diluted with an equal quantity of water, was directed to be given in divided doses, every half-hour.

A catheter being about this time introduced into the bladder, a few ounces of highly coloured urine were drawn off; on testing which with nitric acid there was no change, while heat gave a milky precipitate, which was re-dissolved on the addition of nitric acid.

Towards afternoon, the mucus disappeared from the chest, and she began to show signs of returning sensibility, the pupils contracted and dilated naturally, and about five p.m. she recognised those around her, said she felt thirsty, and asked for a glass of cold water. The stimulants were still continued, and the head symptoms gradually disappeared, except that the mouth remained drawn towards the right side, pulse 100, skin cool and moist. When she was requested, she put out her tongue, which was much loaded, dry, and brown. At this time, the urine was again tested, and the same results were obtained as in the morning. About seven in the evening, the pulse increased in frequency and diminished in strength, and soon became intermittent, so the brandy was increased to a table spoonful every quarter of an hour. At half-past nine, she became very restless and irritable, and complained of being sore all over, on which forty-five drops of the solution of muriate of morphia were given in a dose of the stimulant. About half an hour after the administration of the opiate, she was excited and talked for a few minutes incoherently; she then fell asleep and slept quietly till half-past four in the morning of the 13th, the respirations being twenty-six in the minute, and the pulse calm and regular. About five the breathing again became stertorous, the respirations fifteen in the minute, pupils fixed and contracted and insensible to light, pulse 130, feeble, compressible, and intermitting, skin cold, lips livid. On applying the stethoscope, a mucous râle was heard over the greater part of the chest. The fauces were irritated with a feather, in the hope of exciting vomit

ing, but without success; and an emetic of ipecacuanha was given. The emetic produced great nausea, but caused no vomiting, and after waiting half an hour, a scruple of sulphate of zinc was administered, which caused almost immediately copious evacuation of the contents of the stomach, and seemed greatly to relieve the symptoms. The brandy was resumed, and given in tea spoonfuls every five minutes, with beneficial effect, the pulse falling to 112, the pupils becoming contractile, and the stertorous breathing ceasing. About 11 o'clock a.m., the respiration became very feeble, and the pulse almost imperceptible, and she appeared to be fast sinking, but rallied under larger doses of stimulants.

From this time she continued to improve a little, the respiration being sixteen in the minute, and without any unnatural sound; the pulse became more firm than it had been since the previous evening, and at two o'clock she asked for a drink, and put out her tongue on being requested to do so. The tongue was moist and white. A considerable quantity of urine was now drawn from the bladder, and being tested, was found to give no precipitate with nitric acid or heat, separately or combined; it was of the specific gravity of 1020, and of a deep brownish colour. As the lochial discharge had become foetid and scanty, the vagina was syringed with tepid water. The symptoms continued much the same until four o'clock in the afternoon, when the skin became hot and dry, the face flushed, pulse 130, firm and rather full, respirations twenty-six in the minute. The stimulants were ordered to be omitted while the flushing continued, and the attendant was directed to keep the head cool, and to give the patient plenty of soda water. In about an hour, the skin cooled and the pulse became feeble, the stimulants were accordingly recommenced, directions being given to omit them on the return of an attack of feverishness.

After several remissions and exascerbations, the febrile disturbance became constant, and she was ordered one drachm of the spirit of nitric æther in cold water every other hour.

Four o'clock, morning of June 14th.-Since last report the patient has been in a dozing state. She remained flushed for some hours, during which time the hands and face were frequently sponged with cold water, and the medicine above mentioned exhibited; she has repeatedly recognised those around her, and asked for what she wished. She is now in a state of collapse, with the respirations quick and feeble, pulse 120, soft and thready; tongue moist; mucous râle heard over the lower part of the chest; bowels moved slightly. The attendant ordered to have her shifted from side to side, and to recommence the stimulants, continuing the diuretic medicine. Urine drawn off.

Two o'clock afternoon. The patient is gradually sinking; pulse 140, respirations thirty-six in the minute, feeble and irregular; face contracted, skin cold, mouth not twisted, deglutition difficult; on the left side of the chest there is resonance on percussion, and puerile respiration; the right is very dull on percussion, with bronchial respiration. A blister now directed to be applied over the whole of the back of the right side of the chest, and half a grain of tartar emetic to be given every hour; the brandy and water to be continued.

Four p.m.-Face flushed, skin hot, and bedewed with warm sweat; respirations forty in the minute, pulse 140, rather stronger; mucus of thick viscid quality pouring from the mouth. Stimulants omitted, and the tartar emetic continued.

Half-past nine p.m.-The patient is now unable to swallow; respirations fortyfive in the minute, pulse 140 and feeble; pupils dilated, eyelids closed; mucus bubbling from mouth and nostrils; dulness on percussion on the right side of the chest; bronchial respiration distinctly audible both on the right and left sides; respiration chiefly abdominal. She has bowel complaint. To have a starch enema containing a drachm of tincture of opium, ten grains of gallic acid and two table spoonfuls of brandy.

Four a.m. of 15th.-The enema passed off shortly after being administered, and was repeated in about two hours; patient lies on the back with the mouth open, eyes half closed, face pale, respirations fifty in the minute, pulse 164, consciousness entire. To have the enema every third hour.

Two o'clock afternoon.-Since last report the patient gradually sunk, and died at one o'clock.

No post-mortem examination was allowed.

CASES OF PARTIAL PARALYSIS IN THE LATTER MONTHS OF PREGNANCY.

BY DR GRAHAM WEIR.

Dr Weir shortly detailed the history of two cases of paralysis of the sensitive nerves of the fingers, coming on in the latter months of pregnancy. In the first, the disease came on gradually at the ninth month; the fore-finger and thumb of the right hand were the parts affected. So complete was the palsy, that the patient was unable to feel a needle between the fingers. Immediately after delivery, sensation returned, and has continued perfect ever since.

In the second case, the disease came on about the eighth month of pregnancy; the parts affected were the thumb and two first fingers. The peculiarity in this case was that sensation was not absent, but perverted. A needle placed between the fingers felt by the patient as if it were (to use her own words) of the thickness of a common fire-poker. In this case, recovery was not so immediate as in the former. After delivery, she suffered intense intermittent pain in the middle finger, the paroxysms being synchronous with the after-pains. This state lasted for four days; it then gradually subsided, and she is now able to use the hand as formerly.

Several similar cases were mentioned by other members of the Society.

NIPPLE SUCTION GLASS. BY DR PEDDIE.

Dr Peddie exhibited a 66 Nipple Suction Glass," which he had employed sufficiently often, during the last half-year, to satisfy him of its utility in the cases for which it was designed. For the purposes of drawing out the nipple when flat, and drawing off the milk when the infant was unable to do so, Dr Peddie had made trial of the various instruments and means most generally recommended. The "breast pump" he had tried again and again without success. It is an expensive instrument; and in the hands even of the most intelligent nurse, is constantly getting out of repair, or its application is mismanaged. The old glass trumpet-shaped tube with ball receiver, is an utterly worthless instrument. Attendants also are very rarely met with who will employ the lips simply, or who can do so gently or properly even when willing; and a pup, when procurable-which is not often the case-is a most merciless and injurious tractor. Previous to the use of the instrument now recommended to the notice of the Society, Dr Peddie had employed with most success, a soda or Carrara water bottle, from which the air had been exhausted with hot water.

The "nipple suction glass," is of very simple construction, and can be had at a very trifling cost. The woodcut represents its full size, and will convey the best idea of its shape and peculiarities.

Dr Peddie had also employed another form of the instrument, with a lateral nipple piece.1 The opening to receive the nipple is about seven-eighths of an inch in diameter, the edges being well rounded off. The floor of the glass is applied close to the mamma, whilst the patient assumes a sitting posture. The nurse then holds it firmly in place by two fingers spread out on its back, and applying the lips to the nipple-like projection, makes gentle and slow suction-placing the point of the tongue on the small orifice (about one-twentieth of an inch in diameter) and resting for a few seconds between each draught. By this latter precaution she will avoid giving pain, or drawing blood, while time is given for the enlargement of the nipple and the flow of the milk.

1. In cases of flattened nipples, when the child is dull and weak, and unable to draw them out, the application of this instrument for a few minutes, as directed, will make the nipple large and prominent enough for the child to take hold of it

1 From the difficulty which the glass-blower has experienced in making this form, the instrument with the centre nipplel-ike projection only is recommended.

easily; and will, in instances of first suckling, open up the mammillary orifices, so as to enable them to part readily with the secretion.

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2. In cases where the milk is found in great abundance, and the infant is from any cause unable to afford the needful relief, by means of the glass, and slow, steady, tender suction, aided by a slight expressing movement of the hand on the surrounding gland, the milk will flow freely into the lower part of the glass, which will contain about 3i. before it rises to the level of the nipple.

3. The milk thus drawn off may, if occasion requires, be conveniently given to the infant by placing the thumb on the opening in the floor of the glass, and its nipple fixed in the child's mouth. By covering this orifice with the thumb more or less completely, the milk may be given to the infant in drops, or in a stream, or it may be suspended altogether; and if desired, a teat may be tied to the nipplepiece, and thus the habit of sucking the better kept up in the child.

4. The remaining use of the nipple-glass is its application to one breast, while the mother is in the act of suckling from the other. This is desirable in those instances in which the secretion is very abundant, and flows copiously from the one breast while it is given from the other, thus making the mother's dress most uncomfortable, and exposing her consequently to chills.

MEETING IV.-March 26, 1851.-Dr C. BELL in the Chair.

NOTICE OF A " PULVIS AD PARTUM" IN THE FIRST EDINBURGH PHARMACOPOEIA. BY PROFESSOR SIMPSON.

By the older authors, many different medicines are described as being supposed to have an oxytocic effect upon the uterus; or, in other words, as capable of either originating or increasing the parturient contractions of that organ. From the time of Dioscorides and Galen downwards, various and diversified plants, &c., have been described in medical works, as possessing these alleged virtues. The only two believed at the present day to have a decided oxytocic effect, are ergot of rye and Indian hemp; and both of these plants when used medicinally, seem to possess also in common, a depressing or sedative effect upon the spinal nervous system. Is their oxytocic power dependant upon this action on the centre of the

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