648

slowly as possible, to prevent further lace-ration, but without success; for when thehead descended through the os uteri, theexternal surface of the cylinder, a little be-low the symphysis, presented a transverserupture of about two inches in length, andof considerable depth, without, however, asit appeared, penetrating through the pariesof the uterus. The child was born alive,but died within a few hours. After the re-moval of the placenta, the prolapsed portionof the uterus powerfully contracted; it be-came considerably shortened, but increasedin thickness, so that when Dr. Henschelattempted to return it into the pelvis, its isize occasioned great difficulty. This was,however, at last accomplished. On examin-ing the internal surface of the vagina andlower portion of the uterus in sittc, no traceof any wound could be discovered. Duringand after the laceration, the haemorrhagewas slight, but the sufferings and exhaus-tion of the patient were very great. Emol-lient injections were thrown into the uterus,and small doses of opium given internally.The ensuing night was very restless ; thepatient lost much blood, and complained ofviolent pain over the whole abdomen, whichwas tense and very tender on pressure ; the

upper portion of the uterus had completelycontracted, hut the lower was still very tu-mid and painful. The opium and emollientinjections were continued, and a poulticelaid over the abdomen. On the second

night, the tension and pain of the bellyconsiderably increased; the patient wasvery feverish, and in a desponding state.After the application of an emollient glys-ter, and some leeches to the hypogastric re-gion, the inflammatory symptoms graduallysubsided ; the breasts filled with milk, andthe lower portion of the uterus began to

contract ; so that on the seventh day it hadnearly regained its natural size. The lo-chial flux was very profuse, and containedmuch purulent matter. Four weeks after

delivery, the patient was perfectly cured.On examination of the vagina and uterus,no trace of any previous laceration could bediscuvered ; the uter us was of the naturalsize, and in the lower portion only, therewas a slight degree of tenderness.-Siebold.Journ.fii2- Geburtsh.

UNUSUAL LENGTH OF THE UMBILICAL

CHORD.

In the obstetrical observations of Dr.Schneider, of Fulda, a case is related, inwhich, during’ a very tedious labour, thecontractions of the uterus having been al-most instantaneously excited by a largedose of secale cornutum, a male child wasborn, apparently asphyxiated by the pres-sure of the umbilical chord. which was I

twisted six tines round its neck; but hav-ing been immediately extricated, the childwas restored to life ; the umbilical chordwas five feet five inches in length.

In another case related by the same au.thor, the umbilical chord went twice roundthe neck, and once round the trunk, fromwhence it passed between the thighs to theplacenta. Besides this unusual length, itexhibited a real knot, which, as appearedfrom the gelatinous substance of the chord,had existed a long time before birth.—Ibid,

ANNUAL REPORT OF THE ROYAL LYINC-IN

INSTITUTION, AT DRESDEN.

By PROFESSOR CARUS.

The number of births which occurredduring 1827, was 220, of which thirty-threerequired obstetrical aid, viz., one perforation,one caesarian section, one induction of pre.mature labour, and seven extractions; infour cases the child was turned, in nineteenthe forceps were applied, and in six the

placenta was detached. There was one caseof three children at a birth, and four oftwins ; the number of males was 115, thatof females 110 ; twenty-one girls and eightboys were born prematurely; the largestchild was twenty, the smallest sixteen inchesand a half in length ; the weight varied fromfour pounds and a half to ten and a quarter.Of 223 women who were delivered, notmore than seven died ; the others left thehospital a shorter or longer period after de-livery, perfectly well.In one of the cases where the child was

extracted, the operation was rendered ne-cessary by the umbilical chord having pro-lapsed ; the abdominal surface of the childbeing directed towards the symphysis, itwas turned round its longitudinal axis, butwas born dead: immediately after its birth,a violent haemorrhage ensued, to arrestwhich the placenta was extracted; the uterusshowed, however, no tendency to contract,the haemorrhage frequently recurred, andthe patient died on the seventh day afterdelivery, from loss of blood.

Perforation was performed in a case,

where, from previous rachitis, almost all thediameters of the pelvis were found too

small. The uterine contractions were notsufficient to expel the child, after the remo-val of the brain, and it was necessary toextract it. After ten days the mother wasdischarged cured.The eaesahan operation was performed

on an individual, in whom nearly the wholeosseous system was deformed by rachitis.The length of the whole body was thirty-six inches ; the distance between the cristæileii was eight and a half inches ; betweenthe great trochanters nine inches and a half.

649

Thespinal column was extensively distorted ;the distance of the promontory of the sacrumto the symphysis was two and a half inches,and the cavity of the pelvis was so small,that it was hardlv’ possible to reach thehead of the child. The incision throughtheabdominal skin and linea alba was seveninches long; the child was extracted alive,and did well, but the mother died on thethird day. The wound of the uterus wasfound very widely gaping.Labour was brought on prematurely in a

person, in whom, on account of deformedpelvis, the head of the child had been per-forated in a previous labour. The child being,eight months old, sixteen inches in length,and five pounds in weigiit, appeared per-fectly capable of having lived, but it un-fortunately presented with the feet, and

owing most likely to this circnmstance, wasborn dead. The mother left the hospital onthe ninth day.In the case where three children were

born at a birth, labour was very quick,lasting not more than ten minutes. All thechildren exhibited signs of retarded andincomplete development, and died within ashort time after birth. The quantity of liquoramnii amounted to thirty-four pints; thecommon placenta, two pounds in weight,was eleven inches in diameter. The secre-tion of milk and the lochial flux were regular,and the mother was able to leave the hospitalon the 20th day: —Gemeins.Feitschr. f.Geburtsk.

REPORT OF THE LYING-IN HOSPITAL AT

HEIDELBERG, UNDER PROF. NAEGELE.During the years 1825 and 1826, 415 chil-dren were born, of which 199 were bovs,and 216 girls. In 394, the head, in 4 theface, in 15 the breech or feet, in one the arm,and in another the shoulder presented ;not more than two women died ; 16 chil-dren were born dead, and 19 9 prematurely ;out of which there were three abortions.In six cases twins were born. The forcepswere applied in fifteen cases ; in ten ofwhich the contractions of the uterus wereinsufficient to expel the child ; in threecases the operation was rendered necessaryby the smallness of the pelvis ; and, in two,by the prolapsus of the funis, the head pre-senting.The operation of turning was performed

three ti;nes ; in one case where the shoul-der, in another where the arm, and, in a

third, where the funis presented ; the lastchild only was saved.Perforation was performed in a rachitic

female, who, when brought into the insti-tution, had been several days in labour.The head was forcibly pressed into the

brim; after a very powerful contraction,

the waters escaped, the head remainingimmoveable ; the pains suddenly ceasecl,and the patient complained of a violentburning pain in the belly, and a sensationof faintness; the countenance was pale,the pulse very small, and the extremitiescold ; perforation was immediately per-formed, and the child extracted ; but theuterus did not contract, the belly swelled,and was very tender; the patient becamevery restless, vomited, &c., and died on thesame evening. On examination, the lowerportion of the uterus was found ruptured tothe extent of four inches ; the abdominalcavity was filled with extravasated blood,and exhibited distinct signs ofinflammation.The distance from the promontory of thesacrum, to the symphysis, was three inches.

In a case of very small pelvis, labour wasartificially brought on in the eighth monthof gestation, with complete success.

In a young female, with very large pelvis,labour was unusually quick ; when the headdescended through the external genitals,violent hæmorrhage ensued ; the funis wastwisted round the neck, and fhe body wasborn before it could be loosened. The um-bilical vessels were found extensively lace-rated ; one of the arteries being completelytorn asunder, and the vein partially rup-tured. The child was very pale, and as-phyxiated, but soon after the ligature of thefunis, restored to lifeklinische Annal.

ON SPINAL DEFORMITIES.

By DR. HARRISON.

To the E, ditor of THE LANCET.

SIR,—Ever since my attention has been

particularly drawn to the consideration of

spinal deformity, and the complaints de-pendent upon it, I have been more andmore convinced of the frequency of both,and of their injurious effects upon the health.

So great is their prevalence, in this coun-try at least, that I really believe not onefemale in twenty, above the condition oflaborious servitude, remains wholly freefrom them. In pioof of their tendency toundermine the constitution, it will be suffi-cient to add—1st. That where much de-

formity exists, the sufferer is disqualifiedfrom properlv following any active employ-ment ; he is soon tired with labour, andobliged to desist from further exertion.2dly. The great vessels, fastened internallyto the spine, are unable freely to carry onthe circulation through their contortedtubes ; hence the vital fluid, preternaturallyaccumulated, encourages the formation of