On an examination being made, the right foot of the child was found to present, the cord was prolapsed, and did not pulsate. The tumour, however, was found to be so much softened that it was possible to pass three fingers through the outlet of the pelvis. Professor D’Outrepont brought down the foot, in doing which, he found that the hips had compressed the tumour still more. The chief difficulty was experienced in extracting the head by means of the forceps, which gave the patient considerable pain. The child was still-born, but was speedily recovered. After the birth of the child, the tumour regained its former size, so that the placenta could not be expelled by the natural efforts, and it was necessary to introduce the hand in order to remove it.

The patient recovered rapidly, and returned ten weeks after her delivery, in order to have the tumour removed, which operation was performed by Professor Textor. The growth was found to be fibro-cartilaginous, and was connected neither with the bone nor the periosteum. It weighed 11½ ounces, and was so hard that none but they who were present at the patient’s delivery, could have believed its previous softening possible. The patient was completely cured.—Ed.]

[131] A sudden drink of cold fluid will generally excite contractions of the uterus, owing to the close sympathy which exists between it and the stomach. A couple of ounces, at most, will be sufficient for this purpose, if swallowed quickly; a larger quantity not only fails of its effect, by oppressing the stomach, but, by filling it with fluid, renders almost inert any stimuli or medicines which may afterwards be required.

[132] “Cold injections,” says Dr. Young, “should be thrown into the uterus, and repeated ten or twelve times; as on this the success depends.” (MS. Lectures.)

[133] Essay on Inversion of the Uterus. Dublin Journal for September and November, 1837, quoted by Dr. Churchill on Diseases of Females, p. 317.

[134] Midwifery Hospital Reports. Med. Gazette, May 31, 1834; also Aug. 26, 1837.

[135] “I have reason to believe that a placenta which is entire and uninjured, which is enclosed in the uterus, adherent to it, and shut out from access of air, never becomes putrid.” (Matthias Saxtorph, Gesamm. Schriften.)

[136] [An interesting memoir on retained placenta, by Dr. Edward Warren, of Boston, will be found in the American Journal of Med. Sc. May, 1840, p. 71.—Ed.]

[137] Dr. Churchill observes, “I have found, in several cases of prolapse, that the placenta was situated low down on the side of the uterus, and in some few others that the funis was inserted into the lower edge of the placenta.” (Edin. Med. and Surg. Journal, Oct., 1838.)

[138] [Dr. Churchill in his Researches on Operative Midwifery, subsequently published, has collected the results of 92,017 deliveries, in which there was prolapse of the cord, in 333 cases, or 1 in every 276⅔.—Ed.]

[139] [A figure of this instrument is given in Dewees’ Midwifery, Pl. XVIII. and the method of using it fully described.—Ed.]

[140] In the edition which has been translated into English, A. D. 1612, it is the twelfth chapter.

[141] We subjoin the passages to which we have referred in the three above mentioned cases:—

Case 115. “I cannot implicitly accede to the opinion of roost writers in midwifery, which is, that the placenta always adheres to the fundus uteri; for in this, as well as many former instances, I have good reason to believe that it sometimes adheres to or near the os internum, and that the opening of it occasions a separation, and consequently a flooding.”

Case 116. “The first thing I met with was the placenta, which I found closely adhering round the os internum of the uterus, which, among other things, is a proof that the placenta is not always fixed to the bottom of the uterus, according to the opinion of some writers in midwifery. Its adhering to the os internum was, in my opinion, the occasion of the flooding; for as the os internum was gradually dilated, the placenta at the same time was separated, from whence proceeded the effusion of blood.”

Case 224. “It is generally believed that the ovum, after its impregnation and separation from the ovarium, and its passing through the tuba Fallopiana, always adheres, and is fixed, after some time, to the fundus uteri; in this case the placenta adhered, and was fixed close to and round about the cervix uteri, as I have found it in many other cases, so that upon a dilatation of the os uteri a separation has always followed, and hence a flooding naturally ensues.”

[142] The second edition of Rœderer’s admirable Elementa Artis Obstetriciæ, which was published by his distinguished successor, Wrisberg, in 1766, three years after his death, is that which is chiefly known, although it never had an extensive circulation in this country. The means of communication with the Continent at that time were very different to what they are at present; and although none can regret more than ourselves that Rœderer’s work should have passed unnoticed in Dr. Rigby’s Essay on Uterine Hæmorrhage, still we feel assured that the liberal portion of the medical world, whether in this or other countries, will not attribute this omission to a disingenuous suppression of his name, but rather to the more probable circumstances that, residing in a provincial town, and actively engaged in the arduous duties of an extensive country practice, Dr. Rigby had not enjoyed an opportunity of consulting the work; at any rate, we have good reasons to know that he never possessed it.

[143] Not 1776, as stated by Dr. R. Lee.

[144] Dr. Merriman has also recorded three cases of this kind, one of which occurred to himself; in this case “the placenta was expelled many hours before the child was born;” the mother died from puerperal fever.

[145] [A very interesting account of puerperal peritonitis, as it prevailed in the Pennsylvania Hospital in 1833, is given by Professor H. L. Hodge, in the American Journal Med. Sc., for August, 1833, p. 325, et seq.—Ed.]

[146] This condition of parts bore the closest analogy to the state of the cellular membrane, so constantly observed in fatal cases of phlegmonoid erysipelas, or diffuse cellular inflammation.

[147] [The student may consult, with advantage, Dr. Dewees’s chapter on Phlegmasia Dolens, in his “Treatise on the Diseases of Females,” also the observations of Dr. Mann, in the “Massachusetts Medical Communications,” vol. ii., and the interesting paper, by Professor Walter Channing, in the same work, vol. v. p. 46.—Editor.]