Spirit of the British and American Periodicals. STATISTICS AND CASES OF MIDWIFERY; COMPILED FROM THE RECORDS OF THE PHILADELPHIA HOSPITAL, BLOCKLEY. BY GEO. N. BURWELL, M.D. (From the American Journal of the Medical Sciences, April, 1844). The cases of labour contained in this article occurred from October, 1835, to January, 1844 inclusive, a period of eight and a half years. The duration of pregnancy given in these tables corresponds very well with that ordinarily given. The relation between the time of the last menstruation and the birth of the child is an interesting one. It was noted in 259 cases, as follows: In 1 case menstruation occurred about 5 months before delivery. 11 cases 1 case 11 months and over. at irregular intervals throughout gestation, the appearance of the catamenia being preceded by violent neuralgic pains. The points of interest in this table are 1st, the comparatively small number of cases where the intervening time has been less than 8 months; 18 in 259 cases, or in the proportion of 1 to 15; of these 18 cases, labour came on in 9 of them at 7 months. This large proportion taken in connexion with the results would seem to indicate a disposition of Nature to expel the child at the seventh month of utero-gestation. The question would arise also whether the presentation of the child had any thing to do with this. The case at 5 months was a woman who dated her pregnancy nine months before delivery, but who continued to menstruate regularly until this short period before accouchement-child healthy and weighed 6 pounds. In the cases at 6 months the children were all born alive, and had the average weight of nearly 64 pounds. The second point of interest in this table is the large number of cases at eight and eight and half months. The natural duration of gestation being 9 months, it must follow that these were either premature or the catamenia must have appeared once after conception. The number of cases of labour where menstruation had not taken place for eleven months or longer previous to delivery, is sufficient to shew that regularity of the catamenia is not always necessary to conception. There is one case in this number where the patient had not menstruated for eleven years previously. Twin Pregnancies.-Of 588 labours there were 598 children. Sex. This was noted in 517 cases as follows: males 277; females, 240. This gives a percentage of 53 per cent. males, and 47 per cent. females. Dr. Churchill's tables give 59 41 Registrar General's of England Report gives 51 per cent. males and 49 per cent. females. Weight. The average weight of 100 male children at full term was 71b. ₫ oz. Of 100 female children it was 6 lbs. 8 oz. Still-born Children.-Of the 598 children the large proportion of 54 were dead at birth, or lived only a few hours afterwards. With respect to retention of the placenta the dates were not sufficiently definite to render any inference regarding it positive. Hæmorrhage. Thirty cases of hæmorrhage-twice, before the delivery of the child-15 times before the delivery of the placenta, and after the birth of the child; and 13 times after the expulsion of the placenta. Convulsions. 13 cases during progress of the labour; of these 4 were epileptic; 4 apoplectic; 1 a complication of hysteria with epilepsy; 1 partly cataleptic and partly epileptic. MENINGITIS HOMEOPATHY. A case of this kind was related by Mr. Adams lately before the Dublin Patho logical Society. A young lady, aged 23 years, complained on Christmas-day of sickness and chilliness. Two days afterwards she complained of double vision. On the 28th, she was visited by an eminent Professor of Homœopathy, who undertook the case, as one of fever, which was going on well. Next day she had a convulsion, followed by delirium, &c. We need not notice the symptoms or the treatment. The former were unequivocal of dangerous inflammation in the brain-the latter worse than no treatment at all. The patient craved for fruit, whey, chicken-broth, &c., but these were not allowed, and the bowels were never opened till the day before she died. On dissection, the membranes were highly congested, and the pia mater quite red. Much bloody serum was found in the ventricles and in the spinal canal. The base of the brain was like scarlet cloth! It has been said that the only charge against homoeopathy is the loss of precious time in acute diseases. But we are justified in charging homœopathy with gross ignorance of pathology or the nature of disease. What man capable of interpreting the symptoms of a malady, could think of treating meningitis by tea-spoonfuls of water, without any efficient medicine of any description? The truth is, that the homoeopathists are wholly incapable of recognizing acute diseases; and they therefore treat them all as chronic, or rather as imaginary affections that is, with low diet and no medicine! PROTRACTED LACTATION. With the exception of a case by Dr. Kennedy in this Journal, the following is one of the most remarkable we have met with of Galactirrhoea. It is related by Dr. Green in the September number of the New York Journal. Mrs. T. V., aged 47 years, and the mother of four children, has had abundance of milk for 27 years past. There has been a period of exactly four years and a half between each birth, and the children were allowed to take the breast till they were running about at play. She had now been nine years a widow, and is obliged to have her breasts drawn daily, the secretion of milk is so copious. The distance between the periods of pregnancy is worth the consideration of our political economists, and illustrates the doctrine of Dr. Loudon on the subject of protracted lactation. ON THE ISOLATED TUMOR (OR TUBERCLE) OF THE UTERUS. The fleshy tumor of the uterus is, according to our author, more frequent than is generally supposed, and is often the cause of complaints that go under other names, as prolapsus uteri, menorrhagia, hysteralgia, leucorrhoea, dysme norrhoea, &c. These are often effects of the tumor, which is more frequently seated in the posterior walls of the organ than in any other part. The following cases are illustrative of the subject. "Case 1.-Mrs. Easter, widow, aged 43, mother of six children. Began to have pain in the womb within the last two years. Her principal complaint of pain is in the abdomen, low down in the groin, crossing the belly and settling in the hypogastric region, attended with bearing down and pressing, and a feeling that if something would come away she would be better. The pain is not constant. Sometimes it comes on in short and sudden paroxysms of great severity; sometimes lasts for hours, and sometimes for two or three days. Lying down relieves it; it is increased by lifting or straining, particularly at stool. Sometimes she is afraid to walk, owing to the bearing down in the lower part of the belly. Sitting down at all times causes pain in the left side. She has sundry dyspeptic symptoms. On examination, per vag., a tumor as big as a hen's egg is felt to rise from or in the posterior wall of the cervix uteri, about half an inch above the lip of the os, having around it a distinct sulcus, by which it is circumscribed. It extends towards the left side of the patient; is elastic, rounded, and has a roughened feel on its surface, as if formed of flattened convolutions, divided by shallow sulci, but is not distinctly nodular. It is exquisitely tender, and the examination left a pain (which she describes as beating, hot, burning, dull, or numb) evidently neuralgic, to which much of the distress is doubtless owing, which lasted some time.* In all other respects the uterus appears healthy; it is rather low, and the neck is tilted forwards towards the pubis. Such was the history of the case some months ago. The symptoms still continue, but I have made no recent examination, nor has any treatment been submitted to. "Case 2.-Mrs. Derest, aged 24. Seen July 28, 1837. Enjoyed good health previous to her marriage, four years ago, and never since. Had two miscarriages : no living children. Has been suffering much for some months. Pulse one hundred and tense; bowels costive, urine stringy and passed with pain. The inguinal and hypogastric regions are very painful on pressure, but no tumor can be felt from without. There is a good deal of pain in the back, a sensation of bearing down, and of something obstructing the rectum and the evacuation of fæces, and occasional paroxysms of dreadful pain, lasting for hours. On examination, the uterus was found prolapsed, its os and cervix quite healthy. On passing the finger behind the cervix, and upwards towards the left side (that which is the most painful), a hard, knobbed enlargement is to be perceived; and, per anum, a large tumor can be felt, occupying the hollow of the sacrum, and pressing towards each other the walls of the rectum. The body of the uterus seems enlarged. The examination was followed by severe pain, which lasted several hours. The woman was a patient of Dr. Jas. B. Kissam's. Of the subsequent events of the case, I know nothing, except that she took iodine, and I heard lately that she was still living, and in better health. Since the above was written, I found the following memoranda relating to the patient among my papers. Nov. 26, 1840.-After taking 3 oz. Sol. Iod., considered herself well for a period of two and a half years. The symptoms (the same as before) are again as bad as ever. The extreme tenderness of the posterior lip of the uterus renders the examination of the tumor difficult, but it is certainly smaller than formerly. The anterior lower portion of the body of the uterus is enlarged, irregular, in parts harder than in others, and exquisitely tender to the touch; towards its left side it is pretty distinctly circumscribed as a tumor, but accuracy "The connection between hysteralgia and fibrous tumors of the uterus, has been ably pointed out by Ingleby (Lect., p. 204). He has known of four cases thus caused. In a case of small hard tumor of the upper part of the cervix, extreme tenderness of the vagina was a marked symptom." of examination is forbidden by the pain which is caused by the touch. Jan. 1, 1841. Much relief from the use of Iod. Hydrarg. August, 1844.-No examination since.-Health perfectly good. "Case 3.-H. Green, light mulatto, aged 28 years: seen 9th July, 1837, Married 12 years: two children by her first husband, none by her second-none for several years past. Is stout and active, menstruates regularly but scantily. urinates freely as to quantity, but has occasionally extreme pain at the end of the urethra, after the evacution, causing her to shed tears even. Has also pain in the loins. The belly is not tender, and no tumor can be felt in it. The cervix uteri is hard and stiff, and is, as it were, tilted up towards the opposite side from the tumor. The outer surfaces of the lips of the os are rough, hard, and irregular; and the os itself has the shape of an S. (The speculum was not used.) The finger, in ano, encounters a large tumor springing from the posterior sur face of the uterus, just above the cervix, which is hard and irregular, but does not block up the rectum as much as in the preceding case. There are some circumstances connected with this case which are highly interesting, in the history of the disease. The tumour disappeared very rapidly under the use of iodine, not a vestige of it being left, and for some years I considered the cure as complete. About a year ago I obtained permission to examine the uterus, and was much pained to find that a tumor of some size occupied the site of the former one; in other words, that it was growing again. As no complaint was made at the time, I said nothing about it; but on the 12th of March last, was again consulted, for a return of the old symptoms. A very considerable tumor now occupies the posterior surface of the uterus, reaching towards the sacrum, having a flattened feel, its lower edge rather sharp, tolerably smooth, and rather painful. The function of the uterus is not impaired. Further to increase the probability that these tumors belong to the fibrous variety, a very distinct one is to be felt in the right groin, tender, nearly as large as an egg, and apparently attached to the organ. This latter tumor is much less painful to the touch since leeches were applied over it. The disappearance and subsequent return of the disease are further exemplified in case 4th. "Case 4.-Mary Stevens, colored, aged about 30, married 12 years, and mother of two children, consulted me for pain in utero, prolapsus, and scantiness of the catamenia, Sept. 1837. The lower portion of the posterior wall of the uterus was then swollen and tender. In October, there existed a tumor of considerable size, which, on the 28th November, was recognized by my friend, Dr. G. W. Hodgson, now of White Plains. Per rectum, it could be felt to consist of two rounded portions, as large as walnuts, divided by a central sulcus, and very tender. Under the use of iodine, they became smaller, softer, and more circumscribed, and could be pushed up with the uterus into the abdomen. She complained of pain, weight, and leucorrhoea. On the 1st of May, 1838, the tumor was as large as a walnut, softer, and smooth. During the next six months, it rapidly increased in size, being nearly as large as a small orange. On the 28th March, 1839, she called, stating herself to be some months advanced in pregnancy, and, to my surprise, I could not discover the tumor. She was delivered easily, in due time, of a living child. Some months afterwards, on examining her again, I felt the tumor, elastic, as large as a walnut, of circular shape, very tender on pressure, and occupying its original site. There was a great degree of prolapsus; about this time she was examined by Doctor (now Professor) Gilman. The tumor increased, and is now of considerable size, and causing a good deal of uneasiness, but of late has not appeared to enlarge. A year ago, when a patient of the Northern Dispensary, for dysmenorrhoea, which appeared "A case of spontaneous disappearance of two large fibrous tumors is to be found in the first vol. of Clark on the Diseases of Females,' 1814, 1st ed., p. 250. to subside under the use of the bougie, she was several times examined by my able and zealous colleague, Dr. James Crane, Jun. "The symptoms which may arise from the disease now under consideration, are further illustrated by the following: : Case 5.-" Mrs. Sands, mulatto, aged 20, small and delicate; had been married six weeks. On 19th December, 1839, was exposed to cold: on the 20th, menstruated, as she had always done, with pain, which continued severe until the evening of the 23d, when it abated under the use of anodynes. On the 25th the pain recurred, and she vomited up everything she took. On the next day, general peritonitis existed in a well-marked form, and yielded to the usual treatment. The digestive organs continued to be disordered for some time afterwards, and occasional attacks of pain and tenesmus occurred. On the 13th January she began to complain of a return of the old pain, recurring at frequent intervals, at times distressingly severe. On these occasions she walked about her room, bent double, and almost delirious with agony. I now made a vaginal examination. The uterus was very much prolapsed, the neck tilted forwards, thick and firm, and the os gaping. A large round tumor, springing from the posterior wall just above the cervix, as large as a small orange, of uniform smoothness, hard, and very painful on pressure, occupies the vagina and encroaches considerably upon the rectum. The examination caused pain. The pubic region was tender. She had no particular difficulty in urinating, or in defecation, but had long been annoyed by an inclination to expel something from the rectum; otherwise, previous to her marriage, she had had good health. Every evening, from the date of the examination, until the 28th, she was attacked, about 5, P. M., with excruciating pain in the abdomen, beginning in the groins, during which she tossed about in bed in all directions, imploring the administration of her anodyne (McMunn's El. Op.), which invariably speedily relieved. The tumor soon disappeared under the use of iodyne, but what has been her condition since I have had no opportunity of determining. Case 6." Mrs. Rankins, æt. 30, married 5 years: mother of two children, visited Mar. 4, 1840. Her husband had been absent for thirteen months; immediately on his return, she was attacked with excessive pain in the uterus (having previously enjoyed good health), followed by symptoms of peritoneal inflammation, requiring depletion and anodynes. On the subsidence of the more serious symptoms, she lay in a languid, suffering and highly nervous state until the 1st July, when on a vaginal examination the uterus was found prolapsed, and a tumor was detected, circumscribed and as large as a lady apple, on the posterior wall of the uterus, and toward its right right side. It had the usual elastic feel, and was very painful on pressure, appeared as if lobulated externally, and was very distinct per rectum." Case 7.- "Mrs. Johnson, aged 36, mother of one child, applied to me about one year ago, for certain uneasy sensations about the back, hypogastrium, &c., which led to the discovery of an enlargement in the posterior part of the uterus, of some size, but the particulars of which I cannot recall to my memory. Subsequently she disclosed a large fluctuating tumor upon the right loin, which, on being opened, contained a thin purulent fluid derived from carious bone beneath. The fistula still discharges, and I regret to add that a similar tumor, as large as my two fists, now exists in the left groin and is rapidly enlarging. Notwithstanding, her general health is good. The tumor of the uterus, examined this day, Aug. 3, has lost much of its original circumscribed character, and feels more like a general enlargement of the posterior surface of the organ, increasing in thickness as it ascends, hard, not very irregular, and excessively tender, so as to render the examination difficult. It arises from about half an inch above the os, the portion of neck which is sound not being tender; the uterus is low, its anterior surface healthy. It does not interfere with defecation; menstruation is easy and regular, but scanty; leucorrhoea habitual, and coitus so |