PUERPERAL MANIA.
_Inflammatory or phrenitic form.--Treatment.--Gastro-enteric
form.--Treatment.--Adynamic form.--Causes and symptoms.--Treatment._
There are many points of similarity between puerperal convulsions, and the
disease which we are now about to consider, so that an acquaintance with
the nature of the one, will greatly assist the reader in his study of the
other: the same causes which induce the one, will, with trifling
modification, induce the other; the different species of puerperal mania,
will, therefore, resemble more or less those of puerperal convulsions.
Disorder of the mind, which comes under the head of puerperal mania, is
rarely met with before labour; for when it occurs during pregnancy it is
usually referrible to causes unconnected with that state, as to hysteria;
or is, a form of ordinary mania arising from hereditary predisposition,
cerebral diseases, &c. It is true these are conditions which will render
the patient exceedingly liable to an attack of derangement during labour,
and especially during the puerperal state; but the identity of the
affections cannot well be carried farther.
According to our own experience puerperal mania may occur under one of the
three following conditions, viz.--
1. Where it is attended with, and probably depends upon, cerebral
congestion or inflammation.
2. Where it arises from gastro-enteric irritation.
3. Where it is the result of general debility and anæmia.
The last two rather deserve the title of melancholia.
_Inflammatory or phrenitic form._ We shall divide the inflammatory form
into two species: first, where it is wild and furious delirium with
phrenitis; secondly, where it is connected with, and is the result of,
puerperal fever. The first, usually comes on during labour: the patient is
attacked with violent pain, heat, and throbbing of the head, which are
greatly increased by her efforts during the throes; the pulse becomes
quick and hard; the face flushed and crimson; the eyes wild, and the
manner more and more unnatural: if this state be not promptly checked,
the cerebral excitement becomes more intense, furious delirium follows,
which in its turn is succeeded by coma, effusion and paralysis.
On examination after death the ordinary appearances of fatal phrenitis
manifest themselves, viz. preternatural fulness of the cerebral vessels,
thickening and opacity of the different membranes, softening or even
suppuration of the substance of the brain, extravasation of blood, or
effusion of serum into the cavities or substance of the brain, or between
its membranes.
The other form of inflammatory puerperal mania, is only seen _after_
labour, and is invariably connected with, and preceded by, symptoms of
puerperal fever. These are the cases of puerperal mania, where the disease
comes on with a rigour, a quick pulse, violent headach, and abdominal
pain. In some, the attack has appeared from the very commencement to
concentrate itself upon the brain; but in others, it more frequently
appears in a day or two afterwards, when, from the subsidence of the
abdominal pain, we are beginning to hope that the disease has been more or
less controlled. The patient is suddenly seized with intense headach, and
other symptoms of cerebral congestion, accompanied by disordered mind; but
there is not that degree of furious delirium which is seen in the acute
phrenitis; there is less excitement, but there is also, less strength; the
powers of the system are rapidly giving away, not so much under the
effects of the local disease, as under those of the general affection by
which the local disease has been produced. The patient is frequently both
violent and obstreperous; but we seldom see that state of wild and furious
raving which is observed in acute phrenitis. The former of these two
species is of very rare occurrence, but from not being complicated with
puerperal fever, it is perhaps not so dangerous, if promptly treated, as
the other. Dr. Ferguson, has correctly observed, in puerperal fever, that
"any cerebral disturbance diminishes the chances of recovery," and that
"the presence of delirium in any case is almost always followed by a fatal
result." (_Op. cit._ p. 49, 50.)
The patient in whom we have chiefly observed phrenitic symptoms during
labour were stout, robust, short-necked women, with black oily hair, and a
swarthy complexion: from an early stage they had exerted themselves during
the pain in a most violent and unnecessary degree, and had gradually
worked themselves into that state of excitement, which was followed by the
symptoms above-mentioned: in two instances, it was ascertained that the
patient had received a violent blow on the head, either during pregnancy,
or on some previous occasion. In similar habits the same symptoms have
been observed occasionally to accompany the first appearance of the milk,
or to follow its sudden suppression when established, or a similar state
of the lochia.
_Treatment._ The treatment differs but little from that of the congestive
epileptic convulsions, already described: she must be bled to fainting,
leeches must be applied to the temples, the head shaved and cold applied
to it, the feet should be put into hot water, and the bowels opened by an
active purge of calomel. If the child be not delivered, and the passages
are sufficiently dilated, the forceps should be applied to shorten the
labour.
In the other case, which is accompanied with puerperal fever, the
propriety of bleeding to any considerable extent will be more
questionable; it has probably been already employed in the early part of
the original disease, and her powers more or less reduced by it: we must
here rather trust to leeches and cold to the head, and bringing the system
as soon as possible under the influence of calomel and opium. Whether or
not the improvement which follows in some cases of puerperal fever has
resulted from the use of saline medicines, we will not pretend to
determine; but as, on more than one occasion, we have seen calm and
refreshing sleep succeed their exhibition, it is not improbable that they
might prove useful in this form of the disease.
We presume that these are the cases to which Dr. Gooch has referred, when
he described them as being "attended by fever, or at least, the most
important part of it--a rapid pulse;" and that the majority of them prove
fatal: their unfavourable result, however, is not so much from the local
affection, as from the puerperal fever under which the patient sinks.
Pure phrenitis, which is a rare disease during labour or the puerperal
state, is by no means difficult to control by active antiphlogistic
treatment, if taken in sufficient time, before the brain has suffered any
serious injury; nor is there much danger of her continuing deranged even
after the inflammatory symptoms have been reduced. This appears to be also
the case in that form which attends puerperal fever; but here the danger
to life is so much greater, that we rarely have an opportunity of
ascertaining the duration of the mental disorder after the symptoms of
cerebral inflammation have been subdued, since most of these cases
terminate fatally.
_Gastro-enteric form._ In the gastro-enteric form, the cerebral symptoms
are of a much milder character: the head is perhaps warmer than natural,
and it aches a good deal across the forehead and eyes; the face is seldom
flushed, but it is sallow, the eye is yellow, the tongue is foul, the
breath offensive, and if any evacuations have been passed, they are
excessively unhealthy; the abdomen feels full and loaded, the pulse is
irritable, but devoid of strength; the patient is seldom violent, and if
so, can usually be restrained by the mildest measures. Her previous
history will also assist us in our diagnosis; we shall, probably, find
that she has for some time suffered from constipation and deranged bowels,
or is known to have greatly neglected them before her confinement.
Puerperal mania from this cause is a result of cerebral irritation, not
inflammation, and is a state which will generally cease the moment the
cause is removed. As is the case with puerperal convulsions from
gastro-enteric irritation, so here the moment we break the chain of morbid
sympathies, upon which the disease depends, the symptoms disappear, and
are instantly followed by a clearing up of the mental disorder. It usually
comes on during the first few days after labour, before the patient has
taken the laxative medicine which is customary at this time, and seems to
be excited to an outbreak by any little source of mental annoyance or
irritation. At first, it appears to be little else than giving way to
caprice and temper, but by degrees her manner becomes more changed; and
ultimately she grows violent and unmanageable. The state of mind, however,
is very different to that of the inflammatory form of puerperal mania;
there is no raving delirium, and but a slight degree of incoherence; she
understands what is said to her, but reasons erroneously under the
influence of a false impression. This state rarely proves dangerous either
to her life or her reason, if the proper treatment has been promptly had
recourse to; but where it has been allowed to run on for some time, or she
has been reduced by antiphlogistic treatment under an erroneous fear of
cerebral congestion or inflammation, there may be reason to fear that she
will ultimately sink, or at any rate, that the derangement will become
permanent.
_Treatment._ As the pulse scarcely ever betrays a febrile or inflammatory
condition of the system, for although quick, it is seldom observed to be
full and hard, bleeding is rarely required in this form of puerperal
mania, leeches and cold applications being almost sufficient to control
any symptoms of determination to the head which may be present: it is upon
purgatives that we must place our chief hope in this disease, for until
the bowels have been thoroughly and effectively cleared, there will be
little chance of the symptoms being alleviated. In some cases it is
scarcely credible to what an extent this may be carried; day after day
sees the patient relieved of copious, dark, and offensive evacuations,
which are evidently not merely the result of enormous accumulations in the
bowels, but of excrementitious matters, which are thrown off by the
secreting vessels of the liver and alimentary canal. So far from producing
debility, the pulse rises with each relief and becomes fuller and slower,
the face resumes a healthier aspect, the tongue becomes cleaner, the
headach subsides, reason regains its ascendancy, and this favourable
change is followed by calm and refreshing sleep. We could quote several
cases of our own, in illustration of this form of puerperal mania and its
treatment, where the symptoms have quickly yielded, as soon as the source
of irritation had been removed from the system; the patient has recovered
favourably, although in most instances she has retained a sufficient
recollection of what had passed to feel much vexed and even shocked at,
what she was aware had been, very strange and unruly conduct; but we
prefer selecting Dr. Gooch's thirteenth case, of which the details are
given so graphically, as not a little to enhance the value of it.
"A lady, twenty-two years of age, clever, susceptible, and given to books,
was confined with her first child at ----, -- miles from town: she was
anxious to nurse it; but several days passing with little appearance of
milk, doubts began to be entertained whether she would be able: _she_
thought she would, her nurse and surgeon thought she would not: this led
to irritating discussions; her manner became sharp, quick, and unnatural;
and at the end of a few days she was decidedly maniacal. I and another
physician were now sent for; we found her in a straight waistcoat,
incessantly talking and reciting poetry; her skin was hot, her pulse full,
and much above 100; her tongue covered with a dark thick fur; her bowels
were confined, and her stools excessively dark and offensive; she took a
dose of calomel and jalap, followed by small doses of sulphate of
magnesia; these produced a few evacuations, but they were followed by no
relief; she talked almost incessantly, scarcely ever slept, and was so
violent that it was impossible to keep her in bed without the straight
waistcoat. Thus three days passed from our first consultation. The
physician who attended with me, thinking the case would be protracted,
withdrew, and I was directed to take Dr. Sutherland down with me. As the
purgative had operated very moderately, and the tongue and stools were as
unnatural as at first, he proposed a more active purge. The next morning,
therefore, she took a strong dose of senna and salts, made still more
active by the addition of tincture of jalap; after this had been taken
about three hours, it procured a very large evacuation, nearly black, and
horribly offensive; this was as usual discharged into the bed without any
notice on the part of the patient; it acted again an hour or two
afterwards; but now the nurse, who was sitting by her bed-side, was
surprised to see her turn round, and in a calm and natural manner request
to be taken up, as her medicine was going to operate; her waistcoat was
immediately loosened, and she was taken out of bed, when she voided a
stool of prodigous size, as dark and offensive as the first, and then
walked back to her bed calm and collected. We saw her not many hours
afterwards; her waistcoat was off, she was lying on her sofa perfectly
tranquil, answered questions correctly, manifested no vestige of her
complaint, excepting some strangeness in the expression of her
countenance, and a timidity and abstinence from conversation which was not
natural to her: she recovered rapidly and uninterruptedly." (_Account of
some of the most important Diseases peculiar to Women_, by Robert Gooch,
M. D. p. 156.)
The chances of recovery in puerperal mania, from, gastro-enteric
irritation are as great as they are small in the inflammatory form
connected with puerperal fever: the danger is more from erroneous practice
on the part of the medical attendant, who either prostrates the powers of
life by active depletion, under the supposition that he is treating a case
of cerebral congestion, or aggravates the disorder of the mind into wild
delirium, by the exhibition of opium, to procure sleep. It is in these
cases that we occasionally see so much relief procured by the action of
emetics, as at one time to have been considered nearly specific in this
disease, by some of the French practitioners. If the powers be good, we
cannot agree with Dr. Gooch, in objecting to the use of antimony; when in
a sufficient dose, and combined with ipecacuanha, it is too speedy in its
operation to depress the patient much by nausea, and has the additional
advantage of acting as a rapid and effectual purge: when its action is
over, she usually falls into a sound sleep, perspires freely, and wakes
greatly refreshed.
The indiscriminate use of emetics in puerperal mania, is not less
mischievous than that of bleeding; they are chiefly indicated in those
cases, where, in addition to the symptoms above-mentioned, there are signs
of a foul and oppressed stomach, and where the patient either complains of
nausea, or has already made several attempts to vomit. As soon as the
offending cause is removed, the bowels should be kept open by mild
alterative and laxative medicine, as equal parts of blue pill, compound
extract of colocynth, and extract of henbane, in two pills at night, and a
mineral acid in some bitter infusion during the day. The food should be
bland but nutritious, the mind quietly but agreeably occupied, and all
excitement carefully avoided. In this form of puerperal mania, it is not
only a rare occurrence to find that the disordered state of the mind
continues, when the cause which had produced it no longer exists, but it
is scarcely ever known to return in the patient's subsequent confinements.
In the case which has been so ably recorded by Dr. Gooch, the patient has
since had a very large family, her labours have all been perfectly
favourable, and without the slightest symptom of her former disease.
The _adynamic form of puerperal mania_ is by far the most common species
of the disease, and like the adynamic puerperal convulsions, arises from
causes which produce exhaustion and collapse in the general powers of the
system. It is to Dr. Gooch that we are indebted for a masterly exposition
of this disease, and for having been one of the first to point out its
real character.
_Causes and symptoms._ This form of disordered mind is a disease of true
debility, and is closely allied to delirium tremens, and convulsions
produced by anæmia. It can scarcely be said to deserve either the terms
"puerperal," or "mania," for we frequently see a very near approach to it
in females who are much weakened by hæmorrhage, either from menorrhagia,
malignant disease of the uterus, or abortion; and from being a disease
which arises from great exhaustion, it rather deserves the name of
melancholia, than of mania. In lying-in women, "there are two periods at
which this is chiefly liable to occur; the one soon after delivery, when
the body is sustaining the effects of labour, the other several months
afterwards, when the body is sustaining the effects of nursing." (Gooch,
_op. cit._ p. 109.) In the one case, it is usually the result of profuse
hæmorrhage, in the other, it is produced by suckling her child when she is
not strong enough for this purpose. "I have repeatedly seen the
commencement of mental derangement in women who had recovered from their
confinement and had been suckling several months. Nearly all these cases
were instances, not of mania but of melancholia. They occurred in women
who had been debilitated by nursing. The disease at this period has been
attributed to weaning; but, in all cases, I have seen, the disease has
begun before the weaning, and this measure has been resorted to, because
the patient had neither milk nor strength to fit her for a nurse. There
was a peculiarity about the commencement of the disease which I have
seldom or never noticed at the commencement of mania; there was an
incipient stage in which the mind was wrong, yet right enough to recognise
that it was wrong." (Gooch, _op. cit._ p. 114.)
This half-way state of mind between reason and derangement is frequently
seen in women who have been exhausted by menorrhagia, leucorrhoea, &c., or
who have been drained by nursing. We confess that we can see but little
difference in the effects of anæmia upon the brain and nervous system,
whether it be in the unimpregnated or puerperal state, beyond that, on
account of the great changes which have taken place in the system by the
process of labour, by the secretion of milk, &c., the system is probably
more irritable, and susceptible than it would otherwise be. Nothing is
more common than to see, in cases of menorrhagia, the mind becoming
enfeebled, the memory impaired; the patient begins to find that she can no
longer control her thoughts in the ordinary manner, but that strange
trains of ideas will pass through her mind, the source of which she cannot
explain, and frequently so unaccountably, as to cause her serious
uneasiness: "If this goes on so, I shall lose my senses," is almost a
never failing observation; and the dread that this will be the case, tends
to depress the system still more. The sleep is disturbed by frightful
dreams, or she passes night after night in wakeful restlessness; she
worries herself about trifles, her manner changes, and the mind at length
is quite disordered. The same train of symptoms is a frequent result of
over-suckling, and as Dr. Gooch has justly observed, is not the result of
weaning. "In all the cases which I have seen, months after delivery, the
weaning has been the consequence of the disease, not the disease the
consequence of the weaning. The patients had been reduced in health by
nursing, their memories had become enfeebled, their spirits depressed, and
their minds ultimately disordered; they were directed to wean their
children, because they had neither milk nor strength to enable them to
nurse." (_Op. cit._ p. 130.)
A similar state of mind may be induced at an earlier period and more
suddenly, by the effects of a profuse hæmorrhage, by serious discharges,
which occasionally take place shortly after labour, or even by mental
depression; in fact, by whatever lowers the vital powers to a considerable
extent. In these cases, the very history and appearance of the patient are
sufficient to explain the nature of the disease: her hollow eyes, pale
face, and blanched lip, show distinctly how her strength has been reduced.
The source and extent of her debilitated state will in great measure
determine the degree of danger, and the chances of her recovery. In
ordinary cases of this form there is not much to fear, as far as the life
of the patient is concerned; and the cases which have come under our own
notice confirm the excellent remark of Dr. Gooch, "that mania is a less
durable disease than melancholia; it is more dangerous to life, but less
dangerous to reason." But if the disordered mind has come on shortly after
labour, in consequence of profuse flooding; if the powers of the system
have rallied but imperfectly, and from the tinnitus aurium, strabismus,
half vision, &c., it is evident that the cerebral functions are greatly
impaired; if the nights are passed without sleep, and the days in
continued and exhausting excitement; if the pulse be feeble and rapid, the
skin cold and clammy, the face covered with perspiration, and there is a
disposition to colliquative diarrhoea, we shall have but too much reason
to fear an unfavourable issue; every symptom denotes that the powers of
the system have received a fatal blow, and she either sinks exhausted, or
dies in a state of coma, probably from serous effusion upon the brain. On
the contrary, if in addition to a general improvement, she has enjoyed
some hours of refreshing sleep, there is every prospect, not only of
returning health, but also of reason. A mere gleam of returning reason
without a corresponding improvement of health, will afford but little
satisfaction to the mind of a discerning practitioner, for it gives no
assurance that the danger of fatal sinking is at all diminished.
Disordered mind coming on some weeks after delivery from the effects of
over-nursing, when the patient has been unable to afford the necessary
supply to her child, is seldom attended with so much danger to life, as
where suddenly induced immediately after labour by hæmorrhage: the
intermediate stage between reason and derangement is more distinctly
marked, and is of considerable duration; and the gradually increasing
affection of the mind frequently warns even the patient herself to seek
medical advice before the symptoms become more serious.
We believe that the proportion of patients in whom the mind continues
deranged after their health has been restored, is very small, and feel
convinced that the results afforded by the practice of lunatic hospitals
are far from giving a correct estimate. A large majority of the cases of
derangement in lying-in women are of such short duration that they never
come even under the notice of those members of the profession whose
attention is particularly devoted to this branch of medical practice,
still less do they require to be removed into asylums for lunatics. "The
records of hospitals contain an account of cases which have been admitted
only because they were unusually permanent; they are the picked obstinate
cases, and can afford no notion of the average duration of all kinds; the
cases of short duration, which last only a few days or a few weeks, which
form a large proportion, are totally lost in the estimate of a lunatic
hospital." (Gooch, _op. cit._ p. 125.) The results of Dr. Gooch's
practice, which is known to have been very extensive, and especially in
consultation, shows that out of a considerable number of cases only two of
his patients remained disordered in mind, "and of these, one had already
been so before her marriage." There are two classes of patients in whom
disordered mind is not only much to be apprehended during their lying-in,
but in whom there will be some reason to fear that it may become
permanent; first, in those who have already been deranged, independent of
the puerperal state, or who inherit a strong predisposition to mental
disease; and secondly, in those where hysteria has existed in an unusual
degree during the latter part of pregnancy. These circumstances justify us
in using every precaution in their lying-in to avoid any thing which may
excite the disease; but, as already stated, not only is the disorder of
the mind rarely of any duration, but it is seldom known to recur on any
subsequent occasion.
_Treatment._ Our indications of treatment are two-fold, viz., to rouse and
support the powers of the patient, and to allay as far as possible the
irritability of the brain and nervous system.
If the patient has been prostrated by hæmorrhage, not only a nutritious,
but even a cordial and stimulant diet will be necessary: the emulsion of
egg and brandy, which we have before recommended in anæmic puerperal
convulsions, will here prove very useful; and it must be given in small
but frequently repeated doses, until an improvement is observed in the
pulse and in her general appearance. Under all circumstances, it will
scarcely ever be proper or even safe to confine her to low diet: beaf-tea,
veal-broth, &c. should be given in considerable quantities during the
twenty-four hours; and it is surprising what improvement will even take
place merely from the administration of this bland nutriment. If the face
be pale and the pulse low, wine may be given according to the
circumstances of the case.
To calm the cerebral excitement and procure sleep, sedatives will prove of
the greatest value, and require to be repeated until the nervous system is
fairly under their influence. The intense pain at the vertex, which of
itself is sometimes quite sufficient to produce delirium, the tinnitus
aurium, &c., all cease; the pulse becomes softer, fuller, and slower; and,
even if sleep be not immediately induced, a state of calm tranquillity
follows, in which the mind becomes more composed. The Liquor Opii
Sedativus may be given in a dose of twenty-five minims, and repeated in an
hour or so according to circumstances. The combination of camphor with
morphia, or extract of henbane, is an excellent form, and may be given
with perfect safety to a considerable extent.
The bowels should be opened by the mildest laxatives, such as castor oil,
rhubarb and manna, &c., medicines which will neither act violently, nor
weaken by producing watery evacuations; and, once in every few days, it
will be desirable to rouse the action of the liver by Hydrarg. c. Cretâ,
with extract of hop or gentian. To assist still farther in restoring her
health and strength, she should take an infusion of a vegetable bitter
with a mineral acid. As soon as her strength will permit, a change of
residence may be recommended, and she should remove to some quiet
watering-place, where invigorating air and agreeable scenery and
occupations will assist in completing her recovery.
"The constant attendants on the patient ought to be those who will control
her effectually but mildly, who will not irritate her, and will protect
her from self-injury. These tasks are seldom well performed by her own
servants and relatives.
"If the disease lasts more than a few days, and threatens to be of
considerable duration, her monthly nurse and own servants ought to be
removed, and a nurse accustomed to the care of deranged persons placed in
their stead. Such an attendant will have more control over the patient,
and be more likely to protect her from self-injury." "With regard to the
removal of her husband and relations, this also will be a question; if the
disease threatens to be lasting, it is generally right. Interviews with
relations and friends are commonly passed in increased emotion,
remonstrance, altercation, and obviously do harm: large experience also is
decidedly favourable to separation as a general rule; yet there may be
exceptions, which the intelligent practitioner will detect by observing
the effect of intercourse." (Gooch, _op. cit._ p. 158.)
INDEX.
_Abdomen_ of the foetus, labour obstructed by depositions in the, 284.
Pendulous, 308.
Management of the, 309.
_Abdominal_ muscles, faulty action of the, obstructing labour, 336.
_Abnormal_ Parturition, divisions and species of, 263. See _Dystocia_.
_Abortion_, 141.
Explanation of the term, 141.
Period at which it is most common, 142.
Causes of, 142.
Death of the embryo, 142.
External violence, 143.
Mental emotions, 143.
Irritable uterus, 144.
Symptoms of, 144.
Treatment of, 146.
Prophylactic, 146.
In the attack, 149.
After expulsion, 155.
_Abscess_, mammary, 191.
Treatment of, 192.
_Absorption_ of retained placenta, 358.
_Adynamic_ puerperal fever, 450. See _Puerperal Fever_.
Mania, 473. See _Puerperal Mania_.
_After-pains_, 197.
Causes of, 197.
Utility of, 198.
_Age_, rigidity of the passages from, obstructing labour, 314.
Influence of, on the contractile power of the uterus, 327.
_Allantoidis_ Liquor, situation of the, 54.
_Allantois_, mode of its formation, 70.
Its existence in the human embryo, 70.
Functions of the, 70.
_Amnii_ Liquor spurius, situation of the, 54.
Characters of the, 55.
Source of the, 55.
Use of the, 55.
Formation of the bag of the, 162.
Excessive quantity of, 287.
_Amnion_, description of the, 54.
Formation of the, 69.
Dropsy of the, 287.
_Anatomy_ of utero-gestation, 15.
Of the pelvis, 15.
Of the sacrum, 16.
Of the coccyx, 17.
Of the ovaria, 22.
Of the Fallopian tubes, 28.
Of the uterus, 30.
Comparative, of the, 34.
Of the external organs of generation in the female, 45.
_Anæmic_ puerperal convulsions, 387.
_Anchylosis_ of the foetal joints, obstructing labour, 284.
_Anteversion_ of the uterus, 309.
_Apoplectic_ puerperal convulsions, 387.
_Areola_ of the breasts, 86.
_Arm_, presentation of the, 272. See _Labour_.
With the head, 273. See _Presentation_.
_Arthritic_ inflammation supervening upon puerperal fever, 456.
_Artificial_ premature labour, 250.
_Atony_ of the uterus, 324.
Causes of, 325.
Debility, 325.
Derangement of the digestive organs, 326.
Mental affections, 326.
Age and temperament, 327.
Plethora, 327.
Rheumatism of the gravid uterus, 328.
Inflammation of the uterus, 329.
Treatment of, 339.
_Auscultation_ in the diagnosis of pregnancy, 89.
Uterine souffle, 90.
Funic souffle, 93.
Mode of ascertaining twin pregnancy by means of, 100.
During the pains, 159.
_Axes_ of the pelvis, 21.
_Ballottement_, method of performing, 94.
_Bladder_, distended or prolapsed, obstructing labour, 322.
Stone in the, 323.
_Blastodermic_ Membrane, 65. See _Egg_.
_Blood-vessels_, uterine, enlargement of, during pregnancy, 38.
Their connexion with the placenta, 57, 58.
_Breasts_, changes which they undergo during pregnancy, 86.
Abscess of the, 191.
_Breech_, presentation of the, 210. See _Nates_.
_Brim_ of the pelvis, situation of the, 17.
_Bronchial_ Processes, description of the, 71.
_Cæsarean_ Operation, 243-278.
Indications for its performance, 243.
Different modes of performing it, 246.
History of the, 248.
_Canalis_ venosus, situation of the, 78.
_Caput_ succedaneum, in what it consists, 165.
_Carunculæ_ myrtiformes, how produced, 46.
_Cerebral_ tumours in the foetus, obstructing labour, 283.
_Chest_, morbid depositions in the foetal, obstructing labour, 284.
_Child_, size of, at birth, 281.
Its influence on the duration of labour, 282.
Unnatural form of the, 282. See _Foetus_.
_Chorion_, description of the, 52.
Changes which it undergoes during pregnancy, 53.
_Cicatrices_ in the vagina obstructing labour, 315.
Treatment of, 316.
Of the os uteri, 311.
_Circulation_, foetal, 77. See _Foetus_.
_Clitoris_, anatomical description of the, 46.
_Coccyx_, anatomical description of the, 17.
_Colic_, occurring during pregnancy, 104.
Treatment of, 104.
_Colostrum_, nature and use of the, 190.
_Conception_, false, 112. See _Mole_.
_Constipation_ during pregnancy, 104.
Treatment of, 104.
_Contagious_ nature of adynamic puerperal fever, 458.
_Contracted_ vagina, obstructing labour, 315.
_Contractile_ power of the uterus, derangement of the, 324.
Causes of, 325.
Treatment of, 329.
_Contraction_, hour-glass, of the uterus, 354. See _Placenta, encysted_.
_Convulsions_, puerperal, 376.
Epileptic, 377.
Causes of, 377.
Symptoms of, 377.
Tetanic, 381.
Diagnosis of labour during, 382.
Prophylactic treatment of, 383.
Treatment during the attack of, 383.
Apopletic, 387.
Anæmic, 387.
Symptoms of, 388.
Treatment of, 388.
Hysterical, 390.
Symptoms of, 390.
_Copulative_ Organs, 22.
_Cord_, umbilical description of the, 63.
Vessels of the, 63.
Length of the, 63.
Round the neck of the child, 183.
Ligature of the, 184.
Rupture of the, 364.
Prolapsus of the, 368.
Diagnosis of, 368.
Causes of, 368.
Treatment of, 372.
Reposition of the, 373.
Unusual shortness of the, 288.
Knots upon the, 290.
_Corpus_ Luteum, nature of the, 25.
Appearance of, at different periods after conception, 25.
_Cotyledons_ of the placenta, situation of the, 56.
_Cough_, spasmodic, occuring during pregnancy, 104.
Treatment of, 104.
_Cranium_, presentation of the, 200. See _Presentation_.
_Crotchet_, mode of its application, 260.
_Death_ of the foetus, signs of the, 107. See _Foetus_.
_Debility_, insufficient uterine action from, 325.
_Decidua_ membrana, description of the, 48.
Its connexion with the uterus, 49.
With the ovum, 50.
With the placenta, 51-55.
With the Fallopian tubes, 51.
Vera, 51.
Reflexa, 51.
_De Graaf_, vesicles of, 24.
_Delirium_ occurring during labour, 167.
_Depositions_, morbid, in the foetal cavities, obstructing labour, 284.
_Development_ of the ovum. See _Ovum_.
_Diagnosis_ of pregnancy, 80. See _Pregnancy, signs of_.
Of twin Pregnancy, 100.
_Diameters_ of the pelvis, 19.
_Diarrhoea_ during pregnancy, 105.
Treatment of, 105.
_Diet_ during labour, 179.
Lactation, 195.
_Dilatation_ of the perineum during labour, 166.
_Distended_ bladder, obstructing labour, 322.
_Dropsy_ of the amnion, 287.
_Ductus_ arteriosus, situation of the, 78.
_Duration_ of pregnancy, 136.
Causes which determine the, 139.
Of labour, prognosis as to, 178.
Wigand's views, 178.
_Dystocia_, 263.
Divisions and species of, 263.
Malposition, 264.
Faulty form and size of the child, 281.
Faulty condition of the parts which belong to the child, 282.
Abnormal state of the pelvis, 292.
Faulty condition of the soft passages, 308.
Faulty condition of the expelling powers, 324.
Inversion of the uterus, 345.
Encysted placenta, 354.
Precipitate labour, 361.
Prolapsus of the umbilical cord, 368.
Puerperal convulsions, 376.
Placenta prævia, 393.
Puerperal fevers, 415.
Phlegmatia dolens, 463.
Puerperal mania, 473.
_Dystocia_ epileptica, 381. See _Convulsions, puerperal_.
_Eclampsia_ parturientia, 376. See _Convulsions, puerperal_.
_Egg_, bird's, its analogy with the human ovum, 64.
Blastodermic membrane, 65.
Vitelline membrane, 65.
Yelk bag, 65.
Germinal vesicle, 65.
_Embryo_, development of the, 64.
_Embryulcia_, 261. See _Perforation_.
_Encysted_ Placenta, 354. See _Placenta_.
_Epileptic_ Convulsions, puerperal, 376. See _Puerperal Convulsions_.
_Eutocia_, 156. See _Labour, natural_.
_Evolution_, spontaneous, of the foetus, 270.
_Examination_ during labour, mode of its performance, 174.
_Exostosis_ of the pelvis, 300.
Prognosis in, 305.
_Expelling_ powers, faulty state of the, after the birth of the child,
337.
_Expulsion_, spontaneous, 270.
Of the child, 166.
Delirium accompanying the, 167.
Of the placenta, 167.
_External_ organs of generation in the female described, 45.
_Extirpation_ of the uterus, 332. See _Inversion_.
_Extraction_, method of performing, after turning the child, 239.
After perforation, 259.
_Extra-uterine_ pregnancy, 117.
Varieties of, 117.
Tubarian, 118.
Ovarian, 118.
Ventral, 119.
In the substance of the uterus, 117.
Symptoms of, 118.
Causes of, 119.
Treatment of, 120.
Case of, 120.
_Eye_, rheumatic inflammation of the, after puerperal fever, 456.
_Face_ Presentation, 206. See _Presentation_.
_Fallopian_ Tubes, description of the, 28.
Their agency in impregnation, 29.
Changes which they undergo during pregnancy, 29.
Pregnancy of the, 117.
_Febris_ lactea, 191. See _Milk Fever_.
_Feet_, rules for finding the, in the operation of turning, 237.
Presentation of the, 273. See _Presentation_.
_Female_ Pelvis, distinction between it and the male, 17.
Organs of generation described, 22.
_Fever_, milk, 192. See _Milk Fever_.
Puerperal, 415. See _Puerperal Fever_.
_Fibrous_ structure of the uterus described, 32.
_Flatulence_ during pregnancy, 104.
Treatment of, 104.
_Flooding_, 338. See _Hæmorrhage_.
_Foetus_, characters of a full-grown, 75.
Nutrition of the, 75.
Circulation in the, 77.
Changes which it undergoes at the moment of birth, 78.
Signs of the death of the, 107.
Premature expulsion of the, 141. See _Abortion_.
Size and form of the, at birth, 281.
Morbid depositions in the cavities of the, 284.
Anchylosis of the joints of the, 284.
Spontaneous evolution of the, 270.
_Foramen_ ovale, situation of the, 77.
_Forceps_, description of the, 216.
Varieties of the, 217.
General indications for their use, 221.
Mode of applying the, 222.
History of the, 227.
_Formative_ Organs, 22.
_Fracture_ of the parietal bone of the foetus from pelvic deformity, 302.
_Funic_ Souffle, 93. See _Auscultation_.
_Funis_, 63. See _Cord, umbilical_.
_Funnel-shaped_ Pelvis, 298.
_Gastro-bilious_ puerperal fever, 444. See _Puerperal Fever_.
_Gastrotomy_, 243. See _Cæsarian Operation_.
_Generation_, internal organs of, described, 22.
External organs of, 45.
_Germinal_ Vesicle, 65. See _Egg_.
_Graafian_ Vesicles, description of the, 25.
_Hæmorrhage_, uterine, after the birth of the child, 338.
Treatment of, 339.
In placental presentation, 399.
Treatment of, 406.
_Hand_ and feet, presentation of the, 274. See _Presentation_.
_Headach_ during pregnancy, treatment of, 104.
_Heartburn_ during pregnancy, 103.
Treatment of, 103.
_Hour-glass_ Contraction, 354. See _Placenta, encysted_.
_Hydrocephalus_, obstructing labour, 282.
_Hymen_, description of the, 45.
Unruptured, impeding labour, 316.
_Hysterical_ puerperal convulsions, 390. See _Convulsions_.
_Hysterotomy_, 243. See _Cæsarian Operation_.
_Inclination_ of the pelvis, 21.
_Indusium_, 23. See _Ovaria_.
_Inflammation_ of the uterus, affecting its contraction, 329.
_Inversion_ of the uterus, 345.
Causes of, 345.
Diagnosis of, 346.
Symptoms of, 346.
Treatment of, 347.
Chronic, 351.
_Joints_, anchylosis of the foetal, obstructing labour, 284.
_Kiesteine_, 96.
_Labia_, anatomical description of the, 47.
Varicose and oedematous swellings of the, 317.
_Labour_, premature. See _Premature Expulsion of the Foetus_.
Natural, 156.
Preparatory stage of, 157.
First contractions, 157.
Action of the pains, 158.
Auscultation during the pains, 159.
Effects of the pains on the pulse, 160.
Symptoms during and between the pains, 160.
Characters of a true pain, 161.
Formation of the bag of liquor amnii, 162.
Rigour at the end of the first stage, 162.
Show, 163.
Duration of the first stage, 163.
Second stage of, 164.
Straining pains, 165.
Dilatation of the perineum, 166.
Expulsion of the child, 166.
Third stage of, 167.
Expulsion of the placenta, 167.
Twins, 168.
Treatment of, 169.
State of the bowels, 170.
Management of the first stage, 174.
Examination of the patient, 174.
Position of the patient, 176.
Diet during labour, 179.
Supporting the perineum, 179.
Perineal laceration, 181, 182.
Cord round the child's neck, 183.
Ligature of the cord, 184.
Passage of the shoulders, 184.
Management of the placenta, 186.
After treatment, 188.
Lactation, 189.
Milk fever and abscess, 191.
Excoriated nipples, 193.
Diet during lactation, 195.
Management of the lochia, 196.
After-pains, 197.
Mechanism of, 199. See _Parturition_.
Abnormal, 263.
Precipitate, 361. See _Precipitate Labour_.
_Laceration_ of the perineum, 181, 182.
Of the uterus, 274. See _Rupture_.
_Lactation_, management of, 189.
Diet during, 195.
_Ligaments_ of the uterus, 31.
_Ligature_ of the funis, 184.
_Liquor Amnii._ See _Amnii Liquor_.
_Lochia_, management of the, 196.
_Malacosteon._ See _Mollities Ossium_.
_Male_ and female pelves, distinction between the, 17.
_Malposition_ of the child in utero, 264.
Rareness of its occurrence, 265.
Causes of the, 266.
Symptoms of, 268.
With deformed pelvis, 272.
With rigidity of the uterus, 272. See _Presentation_.
_Mamma._ See _Breasts_.
_Mammary_ Abscess, 191.
_Mania_ connected with precipitate labour, 366.
Puerperal. See _Puerperal Mania_.
_Mechanism_ of parturition, 199. See _Parturition_.
_Membrana_ decidua, 48. See _Decidua Membrana_.
_Membrane_, blastodermic, 65.
Vitelline. See _Egg_.
_Membranes_, formation of the, 48.
Premature rupture of the, 287.
_Menses_, cessation of the, in pregnancy, 83.
_Mental_ affections, impairing uterine contraction, 326.
_Midwifery_, explanation of the term, 13.
Operations of, 216.
Forceps, 216.
Turning, 230.
Cæsarian operation, 243.
Artificial premature labour, 250.
Perforation, 161.
_Milk_ Fever, 191.
Treatment of, 192.
_Miscarriage_, 141. See _Abortion_.
_Mole_ pregnancy, 112.
Nature and origin of, 112.
Diagnostic symptoms of, 114.
Treatment of, 116.
_Mollities_ Ossium, 295.
Causes of, 296.
Pelvic deformity from, 296.
Varieties of pelvic deformity from, 296.
_Monsters_, difficult labour in cases of, 284.
_Movements_ of the foetus, value of, as a sign of pregnancy, 88-94.
_Nates_, presentation of the, 210.
Modifications of, 210.
Varieties of, 210.
Mechanism of labour in, 211.
Diagnosis of, 213.
Management of, 213.
Comparative frequency of, 215.
_Navel-string._ See _Cord, umbilical_.
_Nutrition_ of the foetus, 75. See _Foetus_.
_Nymphæ_, anatomical description of the, 47.
Varicose and oedematous swellings of the, 317.
_Nipples_, excoriated, 193.
Treatment of, 194.
_Oedematous_ swellings of the labia and nymphæ, 317.
_Operations_ in midwifery. See _Midwifery_.
_Operation_, Cæsarian. See _Cæsarian Operation_.
For Inducing premature labour, 253.
_Organs_ of generation, internal, in the female, 22.
External, 45.
_Ossa_ innominata, description of the, 15.
_Ossium_, Mollities, 295. See _Mollities_.
_Os Uteri_, rigidity of the, 310.
Adhesion of the edges of the, 311.
Cicatrices of the, 311.
Agglutination of the, 312.
_Ovaria_, description of the, 22.
Situation of the, 22.
Arteries of the, 23.
Tunica albuginea of the, 23.
Graafian vesicle, 24.
Appearance of the, during childhood, 28.
Diseases to which they are liable, 28.
_Ovarian_ Pregnancy, 118. See _Extra-uterine Pregnancy_.
_Ovaries._ See _Ovaria_.
_Ovum_, development of the, 48.
Membrana decidua, 48.
Chorion, 52.
Amnion, 54.
Liquor Amnii, 55.
Placenta, 55.
Umbilical cord, 63.
Analogy between the human, and the bird's egg, 64.
Order of development, 66.
_Pains_, labour, action of, 158.
Auscultation during, 159.
Effects of, on the pulse, 160.
Symptoms to be observed during and between, 160.
Characters of true, 161.
Straining, 165.
Spurious, 172.
Causes of, 172.
Diagnosis of, 172.
Treatment of, 173.
_Palpitation_ during pregnancy, 104.
Treatment of, 104.
_Parietal_ Bone, fracture of the foetal, from pelvic deformity, 302.
_Parturition_, mechanism of, 199.
Cranial presentations, 200.
Face, 206.
Nates, 210. See _Presentation_; _Labour_.
_Pelvis_, anatomy of the, 15.
Brim of the, 17.
Distinction between the male and female, 17.
Diameters of the, 19.
Before puberty, 20.
Axes of the, 21.
Inclination of the, 21.
Malposition of the child with deformed, 272.
Abnormal state of the, 292.
Equally contracted, 292.
Unequally contracted, 293.
Causes of, 293.
Symptoms of, 298.
Funnel shaped, 298.
Obliquely distorted, 299.
Exostosis of the, 300.
Diagnosis of contracted, 300.
Treatment of, 303.
Prognosis of, 304.
_Pendulous_ Abdomen, obstructing labour, 308.
Management of, 308.
_Perforation_, 256.
History of, 256.
Instruments employed in the operation of, 256.
Indications for its performance, 257.
Extraction after, 259.
Embryulcia, 261.
_Perforators_, different kinds of, 250.
_Perineum_, obstructing labour, 317.
Dilatation of the, 166.
Mode of supporting the, in labour, 179.
Laceration of the, treatment of, 181.
_Peritonitis_, puerperal, 420.
Symptoms of, 420.
Anatomical characters of, 430.
Treatment of, 431.
False, 441.
Symptoms of, 441.
Treatment of, 443.
_Phlebitis_, uterine, 436.
Symptoms of, 436.
Anatomical characters of, 437.
Treatment of, 438.
Crural, connexion of, with phlegmasia dolens, 465.
_Phlegmasia_ dolens, 463.
Nature of, 463.
Definition of, 463.
Symptoms of, 464.
Duration of, 465.
Connexion of, with crural phlebitis, 465.
With puerperal fever, 467.
Causes of, 466.
Anatomical characters, 467.
Treatment of, 469.
_Physiology_ of utero-gestation, 15.
_Placenta_, description of the, 55.
Cotyledons of the, 56.
_Placenta_, decidua of the, 51-56.
Circulation of the uterine blood through the, 57-61.
Sulci of the, 57.
Foetal surface of the, 60.
Expulsion of the, 167. See _Labour_.
Management of the, 186.
In twin cases, 187.
Prævia, 393.
History of, 393.
Symptoms of, 402.
Comparative frequency of, in different years, 405.
Treatment, 406.
Partial presentation of the, 413.
Treatment of, 414.
Retention of the, 337.
Encysted, 354.
Situation of, 354.
History of, 354.
Adherent, 356.
Treatment of, 356.
Left in the uterus, 357.
Absorption of retained, 358.
_Plethora_, effects of, on uterine contraction, 327.
_Plug_, utility of the, in restraining hæmorrhage, 410.
Best means of applying, 152.
_Position_ of the patient during labour, 176.
_Precipitate_ labour, 361.
From violent uterine action, 361.
From deficient resistance, 363.
Effects of, 363.
Treatment of, 365.
Connexion of, with mania, 366.
_Pregnancy_, changes induced in the uterus by, 36.
Seat and appearance of the uterus in the different stages of, 39.
Signs of, 80.
General, 81.
Cessation of the menses, 83.
Areola, 86.
Movements of the foetus, 88-94.
Auscultatory signs, 89.
Ballottement, 94.
Urinary deposites, 96.
Purple hue of the vaginal entrance, 97.
Diagnosis of twin, 100.
Treatment of, 101.
Morning sickness, 101.
Heartburn, 103.
Constipation, 104.
Flatulence, 104.
Colicky pains, 104.
Headach, 104.
Spasmodic cough, 104.
Palpitation, 104.
Toothach, 104.
Diarrhoea, 105.
Pruritis pudendi, 105.
Salivation, 106.
Mole, 112. See _Mole Pregnancy_.
Extra-uterine, 117. See _Extra-uterine Pregnancy_.
Duration of, 136.
_Premature_ expulsion of the foetus, 141. See _Abortion_.
_Premature_ Labour, 141.
Artificial, 250.
History of, 250.
Period for inducing, 253.
Mode of operating, 253.
Rupture of the membranes in, 287.
_Presentation_, cranial, 206.
First species of, 200.
Second species of, 203.
Of the face, 206.
Of the nates, 210. See _Nates_.
Of the arm, 272.
Of the arm with the head, 273.
Of the hand and feet, 273.
Of the head and feet, 274.
Of the placenta, 393. See _Placenta Prævia_.
_Prolapsus_ of the umbilical cord, 368.
_Pruritis_ pudendi occurring during pregnancy, 105.
Treatment of, 106.
_Puberty_, state of the pelvis before, 20.
_Puerperal_ Convulsions, 376. See _Convulsions_.
_Puerperal_ Fevers, 415.
Nature of, 418.
Varieties of, 418.
Pathology of, 418.
Peritonitis, 420. See _Peritonitis_.
Uterine phlebitis, 436. See _Phlebitis_.
Gastro-bilious, 444.
Causes of, 444.
History of, 444.
Symptoms of, 445.
Anatomical characters of, 446.
Treatment of, 446.
Adynamic, 450.
Symptoms of, 450.
Anatomical characters of, 455.
Supervention of arthritic or rheumatic inflammation, 456.
Contagious nature of, 458.
_Puerperal_ Mania, 473.
Inflammatory form of, 473.
_Puerperal_ Mania, treatment of, 474.
Gastro-enteric form of, 475.
Treatment of, 476.
Adynamic form of, 478.
Causes of, 478.
Symptoms of, 478.
Treatment of, 481.
_Quickening_, 88.
_Retained_ Placenta, absorption of the, 358.
_Retention_ of the placenta, 337, 356.
_Retroversion_ of the uterus, 126.
History of, 126.
Causes of, 127.
Symptoms of, 129.
Diagnosis of, 130.
Prognosis of, 131.
Treatment of, 131.
_Rheumatic_ inflammation after puerperal fever, 456.
_Rheumatism_ of the gravid uterus, 328.
Symptoms of, 328.
Treatment of, 333.
_Rickets_, a cause of deformity of the pelvis, 294.
_Rigidity_ of the uterus, malposition with, 272.
Of the os uteri, 310.
Treatment of, 310.
From age, 314.
_Rigour_ after the first stage of labour, 162.
_Rupture_ of the uterus, 274.
Seat of the laceration, 274.
Causes of, 275.
Symptoms of, 276.
Treatment of, 277.
Gastrotomy, 278.
During the early months of pregnancy, 278.
Premature, of the membranes, 287.
Of the umbilical cord, 364.
_Sacrum_, anatomical description of the, 16.
_Salivation_ during pregnancy, 106.
Treatment of, 106.
_Show_, 163. See _Labour_.
_Sickness_, morning, in pregnancy, 101.
Treatment of, 102.
_Signs_ of pregnancy, 80. See _Pregnancy_.
Of the death of the foetus, 107.
_Size_ of a child at birth, 281.
_Spasmodic_ cough during pregnancy, 104.
Treatment of, 104.
_Spontaneous_ evolution, 270.
Expulsion, 271.
_Stone_ in the bladder, obstructing labour, 323.
_Stricture_ of the uterus, 335.
Symptoms of, 335.
Effects of, on labour, 335.
Causes of, 336.
Treatment of, 336.
_Stroma_, 23. See _Ovaria_.
_Structure_, fibrous, of the uterus, 32.
_Sulci_ of the placenta, how formed, 57.
Their connexion with the uterine vessels, 59.
_Tampon_, 410. See _Plug_.
_Temperament_, influence of, on uterine contractions, 327.
_Tetanic_ puerperal convulsions, 381. See _Convulsions_.
_Toothach_ during pregnancy, 104.
Treatment of, 104.
_Tumours_, obstructing labour, 320.
_Turning_, 230.
Indications for, 231.
Mode of performing the operation of, 232.
Rules for finding the feet, 237.
Extraction of the child, 239.
With the nates foremost, 240.
With the head foremost, 241.
History of, 242.
_Twins_, 168.
Management of the placenta of, 168, 187.
_Umbilical_ Cord, 63. See _Cord, umbilical_.
_Unruptured_ Hymen impeding labour, 316.
_Urinary_ deposites in pregnancy, 96.
_Uterine_ Souffle, 90. See _Auscultation_.
Action, violent, 361.
Phlebitis, 436. See _Phlebitis_.
_Utero-gestation_, anatomy and physiology of, 15.
_Uterus_, description of the, 30.
Ligaments of the, 31.
Structure of the, 32.
Comparative anatomy of the, 34.
Changes in the, during gestation, 36.
Situations and appearances of the gravid, 39.
Condition of the gravid, after delivery, 44.
Blood-vessels of the, connected with the placenta, 57, 61.
Retroversion of the, 126. See _Retroversion_.
influence of the form and size of the, on parturition, 266.
Rigidity of the, 272.
Anteversion of the, 309.
Derangement in the contractile power of the, 224.
Rupture of, 274.
Rheumatism of the gravid, 328.
Effects of uterine inflammation in labour, 329.
Stricture of the, 335.
Atony of the, 324.
Inversion of the, 345.
Extirpation of the, 352.
Hour-glass contraction of the, 354.
_Vagina_, anatomical description of the, 45.
_Vagina_, contracted, obstructing labour, 314.
Cicatrices in the, 315.
_Varicose_ swellings of the labia and nymphæ, 317.
_Ventral_ Pregnancy, 119. See _Extra-uterine Pregnancy_.
_Vesicle_, germinal, of the egg, 65. See _Egg_.
_Violent_ uterine action, precipitate labour from, 361.
_Wigand's_ views as to the duration of labour, 178.
_Womb_, 30. See _Uterus_.
_Yelk-bag_, 65. See _Egg_.
THE END.
FOOTNOTES:
[1] On the Ova of Man and Mamiferous Animals, &c.: by T. Wharton Jones.
(_Med. Gaz._)
[2] "Inde vero cum viderum viviparorum testes ova in se continere, cum
eorundem uterum itidem in abdomen, oviductus instar apertum notarim, non
amplius dubito quin mulierum testes ovario analogi sint, quocunque demum
modo ex testibus in uterum, sive ipsa ova, sive ovis contenta materia
transmittatur, ut alibi ex professo ostendam, si quando dabitur partium
genitalium analogiam exponere, et errorem illum tollere quo mulierum
genitalia genitalibus virorum analoga creduntur." (_Nicolai Stenonis
Elementorum Myologiæ Specimen, &c._ Amst. 8vo. p. 145.)
[3] "Ova in omni animalium genere reperiri confidenter asserimus,
quandoquidem ea non tantum in avibus, piscibus tam oviparis quam
viviparis, sed etiam quadrupedibus ac homini ipso evidentissime
conspiciantur." (_Regner de Graaf de Virorum et Mulierum Organis
Generationi Inservientibus._ Lugd. B. and Roterod. 1668. 8vo. p. 299.)
[4] Anat. Descript. of the Human Gravid Uterus: by W. Hunter, M. D.
[5] An Exposition of the Signs and Symptoms of Pregnancy, &c.: by W. F.
Montgomery, M. D. p. 226.
[6] Phil. Trans. 1797.
[7] Purkinje and Valentin, de Phoenomeno generali Motus vibratorii.
Wratisl. 1825.
[8] W. Hunter, Anatomical Description of the Human Gravid Uterus, &c. p.
13.
[9] Vesalius, Malpighi, Morgagni, Diemerbroeck, Vieussens, Ruysch, Monro,
Heister, Haller, Roederer, Meckel, Hunter, Wrisberg, Lobstein, C. Bell.
(_Meckel's Anat._ vol. iv.)
[10] C. Bell, On the Muscularity of the Uterus. (_Med. Chir. Trans._, vol.
iv.)
[11] Leroux, Sur les Pertes de Sang.
[12] The tortuous serpentine course which the arteries of the uterus take,
is not, as has been generally supposed, a provision of nature against the
increase of size which the uterus has to undergo during pregnancy, but is
the result of the structure in which they ramify, having already undergone
these changes during a previous pregnancy.
[13] Anatomical Description of the Human Gravid Uterus, &c.: by W. Hunter,
M. D.
[14] The axis of the brim of the pelvis runs in such a direction, that if
a line were drawn from its centre, it would pass upwards and forwards
through the umbilicus: the gravid uterus has its axis rarely or never
inclined less than this, and usually much more, especially in multiparæ in
whom the fundus is occasionally inclined so strongly forwards as to
receive the name of pendulous belly.
[15] We are inclined to think that the soft feel of the portio vaginalis
is one of the earliest signs of pregnancy which can be detected by
examination. Our attention was first drawn to it in an obscure case of
early pregnancy, complicated with extensive disease, which we examined
with Mr. Ingleby of Birmingham, and where we gave a wrong diagnosis, not
considering the patient to be pregnant. If we had placed as much
confidence in this symptom as we are now inclined to do, we should
probably have formed a more correct view of the case. Since this we have,
on several occasions, found that attending to this circumstance has
considerably assisted us in determining cases of doubtful pregnancy at an
early period.
[16] This description is given according to the lunar not calendar months,
of which there are necessarily ten during the forty weeks of pregnancy.
[17] We are aware that the plan which we follow, in considering the
development of the ovum, is very different to that usually adopted, and
will probably be open to some objections on the score of defective
arrangement; but it must be remembered that this is a work intended for
students, where complete and perfect arrangement must, to a certain
extent, be sacrificed in order to place an acknowledged difficult and
complicated subject in the clearest and most intelligible light. We have,
therefore, preferred describing first the coverings of the ovum during
those periods of pregnancy at which they are most frequently seen, and
shall delay its minute consideration until we come to the description of
the foetus itself, the development of the one being so essentially
connected with that of the other, as to render a separate description of
them impossible. By this means the reader, by having the general details
first brought under his notice, will be enabled to enter with more ease
and advantage upon the consideration of those which are obscure and
difficult.
[18] Siebold's Journal für Geburtshülfe, vol. xiv. heft. 3. 1835.
[19] On the Signs and Symptoms of Pregnancy, p. 133.: by W. F. Montgomery,
M. D. In a note to the above quotation, the learned author very properly
calls them _decidual cotyledons_, "for to that name their form, as well as
their situation, appears strictly to entitle them: but from having, on
more than one occasion, observed within their cavity a milky or chylous
fluid, I am disposed to consider them reservoirs for nutrient fluids,
separated from the maternal blood, to be thence absorbed for the support
and development of the ovum. This view seems strengthened when we consider
that, at the early periods of gestation, the ovum derives its support by
imbibition, through the connexion existing between the decidua and the
villous processes covering the outer surface of the chorion."
[20] Observations by Dr. Baillie, in the posthumous work of Dr. W. Hunter,
on the Anatomy of the Gravid Uterus.
[21] Observations on Certain Parts of the Animal Economy, p. 134.