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æther-inhalation during labour, and so far it is, I vertex or base of the cone, formed by the head and believe, destined to form the commencement of a new body of the fetus, comes first, it may make its transit and important epoch in obstetric practice. But without embryulcio, through a pelvis, the smallness secondly, the case appeared to me to be one of great of which would otherwise have necessitated mutilation moment as an apposite illustration of views which I or the operation of craniotomy." had been previously led to entertain, as to the pos. The essay from wbich I make this extract appeared sibility and propriety of substituting, in some iħstances, in the No. of the Journal that was published on the extraction by the feet for extraction by the crotchet | Ist July, 1847. the delivery of the infant by the hand of the accoucheur A few weeks subsequentiy,-viz., in the Provincial instead of its delivery by instruments-the lateral Medical and Surgical Journal for July 28, Dr. Radford, compression of the child's bead by the contracted sides of Manchester, engaged in the investigation of the of the pelvis, instead of its more dangerous oblique or question, by publishing a communication "On Turning longitudinal compression by the long forceps, and, in Labours rendered Difficult by Distortion of the above all, the transient and not necessarily fatal, depres. Pelvis.” In this communication Dr. Radford aroids sion of the flexible skull of the fretus, for the destructive all allusion, by name or reference at least, to the and necessarily deadly perforation of it.

prerious observations which I had ventured to offer to It is in this second or latter point of view that I the profession on the subject, and he propounds the propose to consider the preceding and other analogous practice to his readers as if it were a new and original cases in the present memoir.

suggestion on his own part, as far as British midwifery In directing the attention of the Obstetric Society is concerned. At the same time, in a spirit of true in January last, to the case which I have stated above, humanity, which does him higla honour, he strongly and its relations to the question of turning, I took declares, that “whatever practice can safely supersede occasion to state that I had practised the same opera- | the murderous operation,-craniotomy,-should be tion as an alternative for craniotomy and the long adopted." “ The records of operative midwifery ought forceps, in other instances in which the head had been not (he observes,) to be stained with so barbarons a morbidly detained at the brim, from the existence of procedure, which, according to the present recog disproportion between the two; and that I believed it to principles of practice, is so unconditionally and so present the following advantages over embryulcio:-It unbesitatingly performed." And, he adds, “ It cannot gave the child a chance of life; it was more safe to the be a matter of surprise that I should, entertaining mother, because it could be performed earlier in labour opinions that craniotomy ought to be considered an and more speedily; it enabled us to adjust and extract operation of necessity, and not of election, hail with the head of the child through the imperfect pelvic brim delight any measure which only promises to lessen the in the most advantageous form and direction, the head / number of these destructive operations." flattening laterally under the traction; the neck (if Afterwards, Dr. Radford proceeds to offer some the child were living or only lately dead,) was so remarks which evidently shew that he has mistaken strong as to allow us to exert such a degree of traction alike in its principles and in most of its details, the upon the obstructed head, that the sides of the cranium alternative operation which I had proposed to substimight become very greatly compressed, or even tute for instrumental delivery; the fault, however, is, indented under it, and that without necessarily destroy. I believe, chiefly or entirely, my own, and is a natural ing the child ; and lastly, it was a practice which could result of the brevity and imperfections of my previous be followed when proper instruments were not at hand, notices on the subject. Indeed, I have reason to know, and the avoidance of instruments was generally de. that Dr. Radford's misconceptions of the proposed sirable, when it was possible.

practice are, on this very account, shared in by many These observations were published in the March others. It is with the anxious view of remedying this number of the “Monthly Journal of Medical Science," defect that I draw up the present communication, and (0.718.) In a later number of the saine Journal, in I trust that the great practical importance of the describing a case of delivery through a pelvis extremely questions discussed in it, will stand as some apology for deformed by maalacosteon, I took occasion to discuss the otherwise unwarrantable prolixity and repetitions in brief terms, the different means of treatment that may possibly be observed in the discussion. required in contracted pelves of different dimensions; In following out the object I have indicated, I will and I repeated in the same words the above advantages treat severally and successively of the kind of cases of turning in comparison with embryulcio. At the which gave rise to the suggestions of the proposed same time I stated in addition, in relation to the theory practice; of the theory, principles, or mechanism of of the practice, that " I believed that when the child the practice; and of its advantages in relation to the presents by the feet, and thus the apex, instead of the curtailment of the duration of labour. I will then

answer the objections which I have heard raised against • I had previously stated the details of the case at page it, in relation to the safety of the infant, and the sately 639, and again at page 721,

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of the mother; and I will, lastly, consider the classes in which the child was extracted footling, in coge of cases best adapted for the practice, and the consequence of its presenting transversely, or with the ditions requisite for its success..

upper extremity.

CASE II.-To a woman who had suffered very Sect.II.-EVIDENCE SUGGESTIVE OF THE PRACTICE.

much in her former labours from the pelvis being disIn studying in their more minute details, the obste. torted," Dr. Smellie was called, and found the breech tric histories of recorded cases of morbid contractions of the child presenting. The extraction of the head, of the pelvis, I have been often forcibly struck with the

required considerable management, but the child was circumstance, that apparently when the child presented

saved. (Collect. 32, Case 10.) præternaturally, and in consequence, ultimately passed CASE III.-Dr. Smellie's assistance was requested with the feet or pelvic extremity first, the labour for a patient with “ the breech presenting, and the seemed frequently both easier and safer to the mother pelvis distorted." The midwife told him “that the and infant, than when, in other labours in the same

woman's former labours had been very difficult and patients, the head of the fetus happened to form the

tedious, but now as the breech presented she was

afraid the difficulty would be greater.” He “saved presenting part. In this way, mothers who had

this child also, although a good deal of force was used always suffered under very severe and instrumental

to deliver the bead.(Ibid, Case 2.) labours, when their children presented with the bead foremost, were, I found, not unfrequently fortunate

CASE IV.-A woman, with the “pelvis narrow," and

“ who formerly was used to have tedious labours," had enough to escape far more easily, when, at other times,

1 a breech presentation. Dr. Smellie brought down the the infant chanced either to present originally with

legs," as the breech did not advance with the assiste the feet, or had the feet artificially brought down lance of the strong pains." The child was delivered during the labour in consequence of the infant lying with difficulty, but alive. (Ibid, Case 13.) transversely with the arm or shoulder constituting the Case V.-A woman, with “ the pelvis distorted and presenting part ;-nay, the history of some few cases awry, from the right ilium being much higher than the incidentally but strongly showed, that when the other," was three times pregnant. The first labour distortion and obstruction in the maternal passages was terminated by craniotomy. The child in the were so great as to have invariably necessitated in all second labour was premature, and presented by the the previous labours the death of the infant by the

arm. It was brought away alive by turning. In her operation of craniotomy, a living child was occasion

third labour the child reached the full time, presented ally at last happily born alive, when it happened to

by the head, was turned, and lost. (Ibid, 34, No. 2, pass or to be brought through the contracted pelves

Case 1.) as an original or artificial footling presentation. In CASE VI.- A woman, with “a narrow and distorted

pelvis, from the three lowest vertebræ of the loins such instances the presentation of a hand or foot, when

bending forward," four times reached the full period of first discovered at the commencement of labour, bas

pregnancy. In her first and third labours the child been regarded as an undoubted source of increased

required to be mutilated by craniotomy before delivery danger and difficulty, but it has at last more frequently

could be accomplished. The infant in the second proved a source of increased safety to the mother, and labour was small, and “ with the greatest difficulty the indirect means of the preservation of the infant. saved, by the assistance of the forceps." At the fourth

As an illustration of these remarks I might appeal confinement the right shoulder of the child presented to the evidence of many different cases observed and Dr. Smellie first tried cephalic version, but failed. He recorded by different authors, without any view to then seized one leg, turned the child, brought out the such a question as that which forms the subject of

body and extremities, and ultimately, after much exer

tion, extracted the head. The child was alive. The the present memoir. But to avoid superfuity of

| mother recovered better than in any of ber preceding proof, I will in the mean time restrict the evidence

labours. (Ibid, No. 5, Case 2.) to a very abridged statement of the cases of the kind, recorded by one or two authors; and for this purpose,

In his “Clinical Midwifery,” Dr. Lee reports the I first select the work of Dr. Smellie, believing, as I following case as one probably similar to those which sincerely do, that his writings are not less remarkable

first suggested the propriety of the artificial induction

i for the strong thoughts and singular practical sagacity

of premature labour :which they display, than for the spirit of candour and

CASE.-The patient had been five times prego truthfulness with which all his facts are reported.

nant. She was delivered of her first child by crani

otomy. Dr. Lee employed the same operation to In his volumes, Dr. Smellie has recorded an unusual

deliver her at her fourth confinement. “At the end number of contracted and distorted pelres; among

of the seventh month of her second pregnancy labour them I find the following cases illustrative of the came on spontaneously, and the child was born alive remarks which I have ventured to offer in the pre- without artificial assistance, and has been reared." ceding paragraphs. The three first cases relate to Her third pregnancy was terminated by labour coming natural pelvic presentations; the two last are instances on at the commencement of the eighth month. “The

Dates presented, and the child was also extracted the ninth month of pregnancy; a foot presented, and alive.” “ Dr. H. Davies induced premature labour at tbe child was extracted dead, without craniotomy.". the seventb and a half month of her fifth pregnancy,

These, I repeat, and similar instances, (and I shall and the child was born alive, but died soon after in

have occasion to quote cases still more striking in the convulsions."

sequel,) appear to me to point eridently to this probable Occurrences similar to wbat bappened in the pre

conclusion,-tbat in particular forms and instances ceding case must, observes Dr. Lee, “originally have I at least, of distorted pelves, the passage of the child suggested the idea of bringing on premature labour | by the feet or pelvic extremity, affords to it and the artificially in cases of distorted pelvis, and probably I mother some special facility of transit which is wanting led, in 1756, to that consultation of the most eminent when the head or cephalic extremity forms the prepractitioners in London, at which the practice was senting part. And we have thus placed before us this approved of, and soon after successfully carried into problem, -upon what does this greater facility and effect by Dr. Macaulay;"* and by a similar study of

safety of footling, as compared with head presentations, the modes of delivery occasiopally adopted by nature

in such cases, depend? Let us proceed to the conin the same cases of distorted pelvis, we bave, I think, sideration of this point, and attempt to ascertain how suggested to us likewise the propriety of artificially this result is obtained. turning and extracting the infant as a footliag pre

• Clinical Midwifery, Case 81, p. 39. sentation. I shall cite only one other case from the

. (To be continued.) same, writer, shewing the degree of difficulty in contracted pelvis to be less when the child passes by a pelvic or footling presentation, than when it presents THE HISTORY OF AN EPIDEMIC CONTINUED and passes by the cephalic extremity.

FEVER,

AS IT OCCURRED IN THE PARISH OF GREAT CASE VII.--A patient, with the outlet and brim of

FINBOROUGH, SUFFOLK, IN THE AUTUMX OF 1846; the pelvis, both considerably contracted, was delivered

RELATED MORE PARTICULARLY AS ILLUSTRATIVE of her first child by craniotomy, after being more than

OF THE DOCTRINE OF CONTAGION, forty-eight hours in labour, and extremely exhausted.

By C. R. BREE, M.R.C.S., Stowmarket. “The difficulty," Dr. Lee remarks, “experienced in extracting the bead with the crochet, after it was

It is not my intention to write a treatise upon ferer; opened, proved that delivery could not have been com- | or to frigbten my brother associates with a lengthened pleted by any other method.” Al her third labour she disquisition upon disputed points, connected with what was again delivered by craniotomy, after the labour Dr. Graves has termed, the most intensely interesting had endured for some time, and four fits of convulsion of all subjects connected with medical scieace. My had supervened. “I found her," says Dr. Lee, “com-object in the following remarks is to state broadly, pletely insensible, with dilated pupils and constant clearly, and I trust oncisely, some of what I thinks convulsive movements of the muscles of the face.

will be found not uninteresting facts, connected with The pains continued with such violence, and recurred at

the all-absorbing subject of continued ferer. such short intervals, that I dreaded rupture of the uterus. * * * The small size of the pelvis,

| The parish of Great Finborougb is situated upon the impossibility of applying the forceps to the head, rather high ground, three miles in a south-westerly the imminent risk of rupture of the uterus, with direction from Stowmarket, on the road to Hadleigh. the result of the former labour, were the circum- Like almost every other rural village in the county of, stances which made me to determine to open the Suffolk, it is distinguished by stagnant ditches, neglected head" At her fourth confinement, the child's head horse-poods, and ill-arranged cess-pools, which are was again perforated. Labour had commenced on more or less to be discovered surrounding the thin, the 2nd of Decenaber; the liquor ampii escaped

cold, damp, confined, lath-and-plaster-built cottages, soon after; the pains continued strong and regular

which are allotted as residences to our labouring poor. during the whole night. On the morning of tbe 8th, (six davs after labour "had commenced,'') the

Its geological characters are simple and easily described.

Fifty, sixty, or seventy feet of alternating blue and head was still wedged in the brim, the abdomen

yellow dilurial clay, or drift as it is termed, with the tense, the patient occasionally delirious, &c., crani.

chalk formation at the bottom, and from four to ten otomy was performed. The patient was thus delivered

feet of heavy loamy soil, at the top. by embryulcio in her first, third, and fourth labours.

I will not say that any of the above points had anyThe history of her second confinement is this,"I

thing to do with my first case of fever, as I was not proposed to induce premature labour on the 21st of

able to trace it to contagion. It will be found that July, 1835, when she was seven months and a ball |

with most of the other cases there was no difficulty in pregnant; but she would not consent to this. Labour

settling this point. For convenience, I bare drawn a came on spontaneously at the commencement of

rough diagram of the parish, numbering the infected

houses corresponding to the cases in the order in which .. .: "Clinical Midwifery," P. 62.

I they occurred.

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"The first case which occurred in the parish was op | But my patient had a long convalescence; although the 25th of August, 1846, at least, this is the date of | after the 5th of September she was safe from the my first visit. As the symptoms in all the cases were imminent danger which had threatened her, and from as similar as could be expected from the same disease' wbich she bad been spatched by the all-powerful affecting different individuals of various ages, I will agency

will agency of port-wine, she had yet to encounter the

effects of disease. Emaciation, great debility, irrita. content myself with briefly describing this case, which

| bility of mind, are, I find, the prominent features of will do ás a type of the rest. Ex uno disce omnes.

my notes of September 11th, and it was some weeks CASE 1.-A. Garrad, the wife of a labouring man before nourishing diet and suitable tonic remedial residing in the cottage marked below, No. 1, sent for agents had restored her to health. me on the 25th of August, 1846. She bad, I found,

1 CASE 2.- On the 21st of September, Susan Pegg, been drooping as it is emphatically termed, for several the roma

the woman who had nursed the above case, told me days; a general sense of debility, weariness, pain in

during my visit that she felt ill. I detected the preher bones, loss of appetite. To these symptoms were

monitory symptoms of fever, and sent her home. added when I saw her; severe pain in her head; dry tongue, furred in the centre, with the edges, and small

By a reference to the diagram it will be seen, that islets here and there, dry, smooth, and perfectly clear;

there is a remote cluster of cottages, to which,—by way, I a quick pulse, 120, small and irritable ; Aushed cheeks, | presume, of special honour,-the name of "city" has and a hot dry surface; abdominal tenderness, and been given. The city, as I know, from many years' exdiarrhæa; urine dark coloured, depositing a thick perience, is situated in the winding of a miserable lane, dusky-coloured sediment.

in an isolated corner of the parish. It consists of five These symptoms gradually increased in intensity, tenements, duly marked and numbered in the diagram. but they were all present when I first saw my patient. From time immemorial it has been celebrated for its In three days, however, the headache had gone on to

open undisguised dirt. Deep ditches filled with stagnant delirium, and on the 31st say notes record-violent

water, open privies, pigsties abutting upon the road, delirium ; great depression marked by loaded tongue; teeth and gums covered with sordes; picking of the

and half obstructing the view of five miserably-built bed-clothes ; cold extremities ; quick irritable pulse;

cottages, are the salient objects in this dreary and in fact, a tendency to death by asthenia. But there melancholy picture. And yet it is not with these, were no spots or vibices, or discharge of blood from viz., pigsties, ditches, and filib, that I am nov w about the bowels either in this or any of the other cases. to find fault, or accuse of any participation in what

Up to this period my treatment had been, cold to I am going to relate. It was here,-to the cottage the head, and sponging the surface with vinegar and marked No. 2,-that Susan Pegg, the nurse of Mrs. water; the daily exhibition of an enema of a cupful

Garrad, was brought, and she went through the disease of starch, containing half an ounce of the syrup of with nearly

with nearly the same symptoms and intensity as No. 1. poppy, (which will generally control the diarrhea ;)

The treatment was the same, with one exception,-i.l., mustard poultices daily to the ankles; and the exbibition of ten grains of the Pulv. Sodæ Comp. of Guy's

I began the wine earlier, on the fourth, instead of the Hospital every six hours, with a draught containing ten

seventh day. She recovered, and her convalescence was grains of carbonate of soda, and three of carbonate of more rapid than in the former case. ammonia, in an ounce of water, erery three hours. As usual, in the country, there was a great outcry

On the 31st, however, it was quite clear that the patient about “the fever," and no one would go near poor was in great danger, and would die, unless I could keep Mrs. Pegg, the mother of eight children, except her alive ; I therefore discontinued the cold and the the wife of John Threadgill, who lives in the cottage medicine, and having procured a bottle of wine, marked No. 3. The cases of ferer that followed Susan directed the nurse to give my patient a wine-glassful

Pegg, in this locality, with the result, were as every three hours, or oftener, according to circum

follows: stancés: my directions being, “the more delirium, the

October 28th, more wine." These directions were well followed up,

CASE 3. Jemima Pegg, aged 12.7 Children of No. 2. and the best part of the bottle was gone next morning.

4. John Pegg, aged 4. The patient was still very ill, but we bad established a 5. Rebecca Pegs, aged 2. )

All recovered. footing, and our enemy was half vanquished. There

October 31st. was more warmth in the extremities; the pulse was

6. Emily Pece
6. Emily Pegg, aged 11. ¿

du Child of No. 2. firmer and fuller, though still ranging from 120 to 130;

Recovered. ånd there was a little moisture on the skin. I kept up

November 2nd. this advantage. On September 5th my patient had

. 7. John Threadgill's wife. { $

l Nurse of No. 2. taken three bottles of wine, and was safe.

i Recovered. I need not describe the process of amendment,-the

November 6th. gradual abatement of delirium, replaced by sleep, I 8. Susan Pegg, aged 14. ? Children of No. 2. the increased action from the skin, the lowering of

9. Ruth Pegg, aged 5. § Recovered. the pulse, and the gradual cleaning of the tongue,

November 19th. these are familiar features, and pleasing ones, too, in CASE 10.--Ann Threadgill, the daughter of No. 7, the diary and the retrospect of all practical men. girl aged 18, left her place at Stowmarket, to purse

ber mother. She was attacked with premonitory, residing at Stowmarket, four miles from his father's symptoms on the 19th, and on the 20th was delirious. residence. After his mother (No. 2,) fell down with She had, in addition to the other symptoms, inflam- the fever, he visited ber sereral times, but preri. mation of the tonsils, which caused great difficulty in ously to the 21st of November he had not been getting either medicine or wine into the stomach. at home for a fortnight. He was attacked with She died on the 5th of December, on the 15th day of fever in Stowmarket on the 21st, and sent home the attack. I injected broth and wine into the rectum, to Finborough, on the 22nd, by the medical officer and believe she was kept alive several days by tbis of the parish of Stowmarket. He had the disease means. This was the only fatal case.

severely, but recovered under the use of large quan. November 21st.

. tities of wine. I did not bear of any case arising Case 11.-Henry Pegg, aged 20, a railway labourer,' in Stowmarket.

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Hitherto we have traced the disease in a regular family or his neighbours, residing in eight or ten unbroken chain of contagion. We have now to follow cottages joining bis own, bad fever. the fever beyond the precincts of the "city," and singu

November 29th. larly enough the next case occurred in a remote parti Case 13.-William Dary, a married man, aged 40, of the parish, and the only two links which will be was attacked on the 29th of November. He had either wanting or doubtful, occur in the next two cases. worked one day with John Threadgill, the father of . . November 27th. ..she

No. 10, and husband of No. 3. His residence is

marked 5. He had the disease mildly, and none of CASE 12.-John Steggall, living in the cottage

his family or neighbours caught it. marked 4, was attacked with the premonitory symptoms of fever on the 27th of November. He had not I have now to relate one of the most singular worked nor spoken with any of the parties or their features in the history I am detailing. By referring to relatives who had hitherto had fever. Mrs. Pegg (No.2,) the diagram and again returning to the city," it will be however, had one day called at the door of the house found that this locality consists of three houses of the farm upon which he worked, for milk; she divided into the residences of five families. Pegg and remained outside the door, and he (Jobo Steggall,) had

11.) Mad Threadgill's history has been related. Locke and his not seen her. He had, however, precisely the same

wife (two elderly people living next door to Threadgill,) kind of fever in its worst form, but recovered under

migrated as soon as the ferer broke out to some friends the same treatment as I have detailed in the first case. This man's home is remote from the city," but in going in a distant parish, and escaped. and returning from his work he passed night and The third house it will be perceived is separated morning, within half a mile of it. None of this man's ) from Pegg's by a garden. This house was inhabited by

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