CONTRIBUTIONS
TO THE PRACTICE
OF MIDWIFERY. By
P. S. Mootooswamy,
F.L.S.,
Member of the British Pharmaceutical Conference, Fellow
of
the Obstetrical and Gynaecological Societies London. Retired Surgeon, Tanjore.
of
No. 1.
Preternatural parturion, second labour, breech about 30, first contook place about 10 or 12 years bach. Labour three days'' duration;, zolien the membranes became ruptured not hnown, interference was indicated on account of arrest of the breech in the holloio of sacrum for about 14 hours, puerperal eclampsia ; delivery ; child male still born, recovery, remarks.
presentation, patient aged
finement
On the forenoon of Tuesday, the 5th November 1889, I was called to a patient in the western main road of the Tanjore town, who was stated to have been in labour of her second child for three days, and was attacked with puerperal eclampsia from 7 P.M. of the previous night. I at once responded to the call, and found the patient lying on a mat in an unconscious state, in a very inconvenient room, her name Thylammay, aged about 30, of Sudra cast, of bilio-nervous temperament, well made, of ordinary stature, and of brown complexion, pupils dilated, skin dry, pulse quick and small, tongue thickly coated, legs and feet cedematous, she the evening was said to have passed water in of the previous day. Bowels constipated for three days. Fits of convulsions occurring every five minutes, there was froth in the mouth, the uterine tumour large, bladder distended, auscultation in the neighbourhood of umbilical region, gave no indication of foetal life, all uterine The labour pains had action had ceased. set in, on the morning of Sunday last, the and inefficient recurring at pains were weak, it is not known when the intervals ; long Liquor Amnii escaped. The first confinement had taken place about ten years ago, the child, a girl, is ^
now
surviving.
On examination the passages hot, dry, and tender, the os uteri rigid, the breech was presenting, but high up, one side of the nates soft and smooth, the bone was felt on firm pressure, and the male genital detected. It was in the anterior dorsal position, the sacrum corresponding to the left plane of the ischium, and the thighs and genitals to the' right sacro-iliac syn-
chondrosis.
a
I relieved the bladder by an elastic large quantity of urine was drawn
having made
an
unsuccessful attempt to
catheter,
off, and to
eva-
the bowels, brirjg down proceeded the nates which slowly progressed, a dose of extract of Ergot, brandy, and water was given, little by little from time to time, which she cuate
I
May
1890.]
CONTRIBUTIONS TO THE PRACTICE OP MIDWIFERY.
swallowed with the greatest difficulty; the fits of convulsions coming 0n oftener than before. I
thought it would be better to lose no time to deliver the child as it was dead. I introduced the blunt hook and one of the inferior extremities was brought out, and then the other; the funis was examined, it was pulseless, the child was successfully brought out to the chest and the superior extremities were drawn out; the next difficulty was the delivery of the head, and it was very tough work. I even thought of perforating the head behind the ear ; the cord was twisted once around the neck. I introduced two fingers of my left baud into the mouth, and two of my right on the back of the neck, and delivered the head with great difficulty, the perineum was carefully supported at the same time ; brandy and ergot were continued during the intervals of the fits of convulsions, the uterus contracted well, and the placenta came away easily (it was of battledore shape) no flooding, the usual abdominal binder applied. The midwife was left to watch the case. The following mixture was given every four hours. R Tinct. Valerian, co. Pot. Bromid Spt. aether, nitrosi
5'iss
...
53s
...
Aqua
...
s'iss
...
oz.
ivss
every four hours, arrowroot congiven for her food. Evening?continues insensible, has had two fits of convulsions since delivery (12m.) made water twice; lochia free; bowels have not acted; quick and third gee to be one
part
pulse
congee given. & Calomel gr. iv to be rubbed on the tongue now, and at 10 p.m. continue mixture Second day, the patient conscious answered the several questions put to her, stated that she had slept for some time, made water twice ; bowels not moved. Lochia not free ; had taken three doses of mixture; tongue continued furred ; pulse quick and weak. Has had no fits of convulsions ; of severe pain of complaining the uterine region. She does not know what had happened to her. enema was
weak,
no
Turpentine
administered which gave but balous motion.
one
solid and scy-
R
Calomel Antim. Tart.
Op**
er. ...
gr. gr.
21 x
^ ft. pill three times a day. Apply turpentine frictions to the lower part of abdomen. ...
R Tinct. valerian, Pot. Bromid
for bed time.
Spt. aether nitr. Aqua camphor
co.
... ... ... ...
-S3
gs
|ss
x
oz.iss,
Third
137
day.?Slept,
severe paiu of the uteriue urine free. Bowels not acted iro change iu the lochial discharge, is complaining of pain, and inability of moving the ri^ht lower limb, skin dry, pulse quick. Continue pill calomel, turpentine friction and
region continues,
night draught. R
Pill Rhei co. Ext. colocynth Do. nuxvomica
...
...
...
gr. gr. gr.
v v
? ft.
for bed time. Fourth day.?Slept, bowels acted once, voided urine three or four times, is complaining of dis-
pill
tension,
and pain of her breast. The patient transferred to the treatment of a native Vythiani, the relatives of the patient not requiring my services any longer. 10th?For the interest and progress of the case, I visited her, and she complained of purulent discharge per vagina iu lieu of lochia, the pain and inability to move the right lower limb continues. has also swellings in 16th?The woman both groins, evidently she is suffering from phlegmasia dolens. I visited her twice at intervals of two and three weeks, and found that she was doing well. was
Remarks.
calling for remarks is an instance of which occurred during lacmvulsious puerperal bour,it presents several points of interest. First the age of the patient is 30 for her second confinement, having had her first delivery about 10 or 12 years back, which rendered the soft parts rigid. Second, the prejudice that exists among natives of not giving purgatives to females during pregnancy, as iu the present case ; she took no purgative medicine after her fifth month, and her bowels were constipated three days at the time of labour. Thirdly, the patient was neglected from the outset, so much so, that nobody knew when the membranes were ruptured, and fourthly, the presentation (breech) remained arrested for several hours (14) at the time I was called in. It is not therefore surprising that convulsions should have set in, from the violent fits of which, the foetus in utero must have died during the earlier attacks. No sooner the woman was delivered of the child, the paroxysms of convulsions ceased, which evidently indicated that the presence of the dead child was a source of irritation to the of eclampmother, thus favouring the sia. Were it not for the delivery, as late as it was, the patient would have fallen a victim to this formidable disease. The
case
invasion
The particulars during the post partum period consisted in the continuance of the constipation of the bowels, which were only relieved by the exhibition of euemata, aud purgative ^
19
THE INDIAN MEDICAL GAZETTE.
1.38
medicine.
The locliial discharge was not free, and was followed by purulent discharge; the usual uterine inflammation, and mammary symptoms followed, these were combated by the usual plan of treatment. She was next attacked with phlegmasia dolens, no sooner she was transferred to native treatment. It is a great mistake on the part of natives, that the services of professional skill are only resorted to when all native efforts become ineffectual, and as soon as the patient is relieved of the impending danger, she reverts again to native treatment. I have had several cases of puerperal contreatment under before and vulsions my during labour, and after delivery, most of them from the two former varieties proved fatal, while a few have recovered. I had a case of severe puerperal convulsions in a young respectable Bramin lady in her fifth month of first pregnancy, but she recovered therefrom, went through her full term of utero-gestation,had an easy labour, and gave birth to a still-born female issue, the mother making a good recovery. No. 2.
A. M., the 29th called to attend upon a case of labour in the town of Tanjore out of the fort, about half a mile south of my residence. The woman in labour of her first child, for the past three days; named Ilutheramariammal, aged about 20, native Christian, of weak and delicate make, of leucophlegmatic temperament. The labour pains set in three days ago. on the morning of Wednesday last, but they were said to be weak and inefficient, recurring at long intervals, for which a dose of castor oil was given yesterday morning, which operated three times, skin natural, pulse frequent, tongue clean, urine free. Liqr. amnii escaped about 3 A.M. this morning, head presented, the progress of labour having been very slow, three doses of ergot and brandy were given. After 7 A.M. the head descended, and became arrested in the outlet ever since, there was uo rigidity of the perineum; and the child could not be born for want of uterine action, the abdominal binder was tightened, but it had not the desired effect. There were puerperal convulsions of the hands and legs and fixing of the eye-balls upwards; these symptoms alarming the relatives of the patient, induced them to send for me. I arrived about 10 A. M., and found the patient in a delicate state of health, anxious, restless, and becoming exhausted. 1
On
Friday forenoon about
Decenibtr 18S9, I
was
hastily
9ij?
1890.
satisfied myself that the head was only arrested, but not impacted, and there was an indication of foetal life. A dose of ergot and brandy had been given, I delivered the child by the short forceps, carefully supporting the perineum. The issue was a living male child, and it had the umbilical cord twisted once around its neck, it, was a small child, and was nearly asphyxiated ; it was however resuscitated by artificial respiration. There was no flooding, the woman rallied after a while, the uterus contracted well, and the placenta was expelled, it was of the natural form. Immediately after the delivery of the child, the patient became speechless, and expressed her wants by the motions of her hands. She Some time after, was dressed and put to bed. the abdomen became tympanitic, and a dose of Tinct. Valerian, co. and musk was given. I have heard of this patient that since her arrival from Trichinopoly to this place for her confinement, about three months back she was in a sickly state of health, suffering from a large ulcer of syphilitic origin on the back of her left shoulder, and has rheumatic pains of her joints, and pleurodynia. for some water, bowels not moved, skin dry, pulse quick ; ordered a cup of arrowroot congee to be given at once. 4 p. M.
Difficult parturition, primipara. Patient aged about 20, head presentativn arrested in the outlet, threatened tvith puerperal convulsions, delivery completed by the short forceps, Aphasia immediately after delivery ; recovery ; remarks.
[May
time, made
Aphasia continues, slept 110
3rd November 1889, 7 a. m. The patient looks well, aphasia continues, took a cup of congee drawn off at 7 P. as ordered, and the urine was
slept last night; bowels acted once ; 110 urine voided, it was again drawn off this morning,
M. ;
the
tympanitic
state
of the
Lochia free, complaining of region, skin dry, and pulse is doing well.
abdomen subsided.
pain of the uterine quick. The child
R.
Calomel
...
Antim. Tart
...
Opii twice
a
...
gr. gr. gr.
ii^ 1
?
day.
ft.
pill
E. Tinct Valerian, Inf. Valerian.
day,
times
a
pill
apply
;
...
...
5SS ozim
three
interval of an hour after the turpentine fomentation to the lower at
an
of abdomen. To have toast and
part
co.
tea, continue arrowroot congee. ls< December?No change in her speech, slept, complains that the pain of the uterine region is Lochia free, bowels acted once, urine severe. drawn off again last night, and this mornwas ing ; patient's mother reported that her daughter perspired much during the night. ConTo have a cup of arrowroot at once. and mixture. tinue pill Turpentine stupes, to have toast and chicken broth (or her dinuer.
May
Dr. CUNNINGHAM ON COMMA-BACILLI.
1890.]
2nd December?The patient began to speak last evening, slept, states that she feels easier of the pain of the uterine region, but complains Bowels of pain and distension of her breast. acted once, she passed her urine herself this morning for the first time; skin dry, pulse accelerated. Omit calomel pill, continue mixture twice a day, apply poppy head fomentation to the breast. 3rd December?The patient speaks well, this morning, and states that she feels better of the pain in her breast, and that she has suckled her baby ; bowels regular ; lochia free ; urine normal.
Continue medicament. 7th, Improving, omit medicine.
19th, Doing
well.
Remarks. There are a few points worthy of remark in the above case, the first is the inertia or want ot muscular tor.e of the fundus of the uterus for the purpose of expelling the child ; thereby the second stage of labour had become prolonged, the woman becoming exhausted; this may be attributed to the weak, delicate, and sickly state of the patient. It was prudent on the part of the relations to have the presence of mind to send for professional skill in time whereby there was a chance of saving two lives, the mother and the infant. The operation was resorted to eight hours after the rupture of the membranes. Second, the threatening of puerperal convulsions during the second stage of the labour, and third, the sudden appearance of aphasia which came on immediately after labour, it was only transitory lasting three days?a phenomenon. I have rarely observed it in my practice ; the cause for its appearance, in the present instance it is not easily accountable. Dr. Tanner.is of opinion, thatthe presence of some syphilitic deposit, or any other kind of tumour may cause it. The woman is very fortunate indeed that the occurrence was only temporary, and being unaccompanied by hemiplegia. Dr. Leishman in his Midwifery page 828 observes : " several cases of cerebral embointeresting lism aftei parturition have been narrated by Dr. Hughlings Jackson, Fordy ce. Baker, and others; as in other cases of this lesion, the middle cerebral artery on the left side seems to be the most iiequent, and so we find that aphasia is one of the symptoms occasionally observed. From two cases recently under t|ie observation of Dr. Finlayson in the Glasgow "Western Infirmary it would appear that there may be a repetition of this accident, both of the women referred to, suffered from aphasia, which came on within a few days after labour, and after making a tolerably complete recovery, both were seized after their next labour
139
with a very aggravated and persistent form of the aphasia, in one of the cases the right hemiplegia was extreme, but in the other it was
slight."
In the post partum treatment of the case, there was nothing particular with the exception of aphasia, and the urine was obliged to be drawn off, for three or four days; this was probably owing to paralysis of the bladder, the result of the pressure of the head of the child during the arrest. As very few cases of the kind have appeared in the pages of the Indian Medical Gazette I therefore venture to send the above for record
therein.
TO THE PRACTICE
OF MIDWIFERY. By
P. S. Mootooswamy,
F.L.S.,
Member of the British Pharmaceutical Conference, Fellow
of
the Obstetrical and Gynaecological Societies London. Retired Surgeon, Tanjore.
of
No. 1.
Preternatural parturion, second labour, breech about 30, first contook place about 10 or 12 years bach. Labour three days'' duration;, zolien the membranes became ruptured not hnown, interference was indicated on account of arrest of the breech in the holloio of sacrum for about 14 hours, puerperal eclampsia ; delivery ; child male still born, recovery, remarks.
presentation, patient aged
finement
On the forenoon of Tuesday, the 5th November 1889, I was called to a patient in the western main road of the Tanjore town, who was stated to have been in labour of her second child for three days, and was attacked with puerperal eclampsia from 7 P.M. of the previous night. I at once responded to the call, and found the patient lying on a mat in an unconscious state, in a very inconvenient room, her name Thylammay, aged about 30, of Sudra cast, of bilio-nervous temperament, well made, of ordinary stature, and of brown complexion, pupils dilated, skin dry, pulse quick and small, tongue thickly coated, legs and feet cedematous, she the evening was said to have passed water in of the previous day. Bowels constipated for three days. Fits of convulsions occurring every five minutes, there was froth in the mouth, the uterine tumour large, bladder distended, auscultation in the neighbourhood of umbilical region, gave no indication of foetal life, all uterine The labour pains had action had ceased. set in, on the morning of Sunday last, the and inefficient recurring at pains were weak, it is not known when the intervals ; long Liquor Amnii escaped. The first confinement had taken place about ten years ago, the child, a girl, is ^
now
surviving.
On examination the passages hot, dry, and tender, the os uteri rigid, the breech was presenting, but high up, one side of the nates soft and smooth, the bone was felt on firm pressure, and the male genital detected. It was in the anterior dorsal position, the sacrum corresponding to the left plane of the ischium, and the thighs and genitals to the' right sacro-iliac syn-
chondrosis.
a
I relieved the bladder by an elastic large quantity of urine was drawn
having made
an
unsuccessful attempt to
catheter,
off, and to
eva-
the bowels, brirjg down proceeded the nates which slowly progressed, a dose of extract of Ergot, brandy, and water was given, little by little from time to time, which she cuate
I
May
1890.]
CONTRIBUTIONS TO THE PRACTICE OP MIDWIFERY.
swallowed with the greatest difficulty; the fits of convulsions coming 0n oftener than before. I
thought it would be better to lose no time to deliver the child as it was dead. I introduced the blunt hook and one of the inferior extremities was brought out, and then the other; the funis was examined, it was pulseless, the child was successfully brought out to the chest and the superior extremities were drawn out; the next difficulty was the delivery of the head, and it was very tough work. I even thought of perforating the head behind the ear ; the cord was twisted once around the neck. I introduced two fingers of my left baud into the mouth, and two of my right on the back of the neck, and delivered the head with great difficulty, the perineum was carefully supported at the same time ; brandy and ergot were continued during the intervals of the fits of convulsions, the uterus contracted well, and the placenta came away easily (it was of battledore shape) no flooding, the usual abdominal binder applied. The midwife was left to watch the case. The following mixture was given every four hours. R Tinct. Valerian, co. Pot. Bromid Spt. aether, nitrosi
5'iss
...
53s
...
Aqua
...
s'iss
...
oz.
ivss
every four hours, arrowroot congiven for her food. Evening?continues insensible, has had two fits of convulsions since delivery (12m.) made water twice; lochia free; bowels have not acted; quick and third gee to be one
part
pulse
congee given. & Calomel gr. iv to be rubbed on the tongue now, and at 10 p.m. continue mixture Second day, the patient conscious answered the several questions put to her, stated that she had slept for some time, made water twice ; bowels not moved. Lochia not free ; had taken three doses of mixture; tongue continued furred ; pulse quick and weak. Has had no fits of convulsions ; of severe pain of complaining the uterine region. She does not know what had happened to her. enema was
weak,
no
Turpentine
administered which gave but balous motion.
one
solid and scy-
R
Calomel Antim. Tart.
Op**
er. ...
gr. gr.
21 x
^ ft. pill three times a day. Apply turpentine frictions to the lower part of abdomen. ...
R Tinct. valerian, Pot. Bromid
for bed time.
Spt. aether nitr. Aqua camphor
co.
... ... ... ...
-S3
gs
|ss
x
oz.iss,
Third
137
day.?Slept,
severe paiu of the uteriue urine free. Bowels not acted iro change iu the lochial discharge, is complaining of pain, and inability of moving the ri^ht lower limb, skin dry, pulse quick. Continue pill calomel, turpentine friction and
region continues,
night draught. R
Pill Rhei co. Ext. colocynth Do. nuxvomica
...
...
...
gr. gr. gr.
v v
? ft.
for bed time. Fourth day.?Slept, bowels acted once, voided urine three or four times, is complaining of dis-
pill
tension,
and pain of her breast. The patient transferred to the treatment of a native Vythiani, the relatives of the patient not requiring my services any longer. 10th?For the interest and progress of the case, I visited her, and she complained of purulent discharge per vagina iu lieu of lochia, the pain and inability to move the right lower limb continues. has also swellings in 16th?The woman both groins, evidently she is suffering from phlegmasia dolens. I visited her twice at intervals of two and three weeks, and found that she was doing well. was
Remarks.
calling for remarks is an instance of which occurred during lacmvulsious puerperal bour,it presents several points of interest. First the age of the patient is 30 for her second confinement, having had her first delivery about 10 or 12 years back, which rendered the soft parts rigid. Second, the prejudice that exists among natives of not giving purgatives to females during pregnancy, as iu the present case ; she took no purgative medicine after her fifth month, and her bowels were constipated three days at the time of labour. Thirdly, the patient was neglected from the outset, so much so, that nobody knew when the membranes were ruptured, and fourthly, the presentation (breech) remained arrested for several hours (14) at the time I was called in. It is not therefore surprising that convulsions should have set in, from the violent fits of which, the foetus in utero must have died during the earlier attacks. No sooner the woman was delivered of the child, the paroxysms of convulsions ceased, which evidently indicated that the presence of the dead child was a source of irritation to the of eclampmother, thus favouring the sia. Were it not for the delivery, as late as it was, the patient would have fallen a victim to this formidable disease. The
case
invasion
The particulars during the post partum period consisted in the continuance of the constipation of the bowels, which were only relieved by the exhibition of euemata, aud purgative ^
19
THE INDIAN MEDICAL GAZETTE.
1.38
medicine.
The locliial discharge was not free, and was followed by purulent discharge; the usual uterine inflammation, and mammary symptoms followed, these were combated by the usual plan of treatment. She was next attacked with phlegmasia dolens, no sooner she was transferred to native treatment. It is a great mistake on the part of natives, that the services of professional skill are only resorted to when all native efforts become ineffectual, and as soon as the patient is relieved of the impending danger, she reverts again to native treatment. I have had several cases of puerperal contreatment under before and vulsions my during labour, and after delivery, most of them from the two former varieties proved fatal, while a few have recovered. I had a case of severe puerperal convulsions in a young respectable Bramin lady in her fifth month of first pregnancy, but she recovered therefrom, went through her full term of utero-gestation,had an easy labour, and gave birth to a still-born female issue, the mother making a good recovery. No. 2.
A. M., the 29th called to attend upon a case of labour in the town of Tanjore out of the fort, about half a mile south of my residence. The woman in labour of her first child, for the past three days; named Ilutheramariammal, aged about 20, native Christian, of weak and delicate make, of leucophlegmatic temperament. The labour pains set in three days ago. on the morning of Wednesday last, but they were said to be weak and inefficient, recurring at long intervals, for which a dose of castor oil was given yesterday morning, which operated three times, skin natural, pulse frequent, tongue clean, urine free. Liqr. amnii escaped about 3 A.M. this morning, head presented, the progress of labour having been very slow, three doses of ergot and brandy were given. After 7 A.M. the head descended, and became arrested in the outlet ever since, there was uo rigidity of the perineum; and the child could not be born for want of uterine action, the abdominal binder was tightened, but it had not the desired effect. There were puerperal convulsions of the hands and legs and fixing of the eye-balls upwards; these symptoms alarming the relatives of the patient, induced them to send for me. I arrived about 10 A. M., and found the patient in a delicate state of health, anxious, restless, and becoming exhausted. 1
On
Friday forenoon about
Decenibtr 18S9, I
was
hastily
9ij?
1890.
satisfied myself that the head was only arrested, but not impacted, and there was an indication of foetal life. A dose of ergot and brandy had been given, I delivered the child by the short forceps, carefully supporting the perineum. The issue was a living male child, and it had the umbilical cord twisted once around its neck, it, was a small child, and was nearly asphyxiated ; it was however resuscitated by artificial respiration. There was no flooding, the woman rallied after a while, the uterus contracted well, and the placenta was expelled, it was of the natural form. Immediately after the delivery of the child, the patient became speechless, and expressed her wants by the motions of her hands. She Some time after, was dressed and put to bed. the abdomen became tympanitic, and a dose of Tinct. Valerian, co. and musk was given. I have heard of this patient that since her arrival from Trichinopoly to this place for her confinement, about three months back she was in a sickly state of health, suffering from a large ulcer of syphilitic origin on the back of her left shoulder, and has rheumatic pains of her joints, and pleurodynia. for some water, bowels not moved, skin dry, pulse quick ; ordered a cup of arrowroot congee to be given at once. 4 p. M.
Difficult parturition, primipara. Patient aged about 20, head presentativn arrested in the outlet, threatened tvith puerperal convulsions, delivery completed by the short forceps, Aphasia immediately after delivery ; recovery ; remarks.
[May
time, made
Aphasia continues, slept 110
3rd November 1889, 7 a. m. The patient looks well, aphasia continues, took a cup of congee drawn off at 7 P. as ordered, and the urine was
slept last night; bowels acted once ; 110 urine voided, it was again drawn off this morning,
M. ;
the
tympanitic
state
of the
Lochia free, complaining of region, skin dry, and pulse is doing well.
abdomen subsided.
pain of the uterine quick. The child
R.
Calomel
...
Antim. Tart
...
Opii twice
a
...
gr. gr. gr.
ii^ 1
?
day.
ft.
pill
E. Tinct Valerian, Inf. Valerian.
day,
times
a
pill
apply
;
...
...
5SS ozim
three
interval of an hour after the turpentine fomentation to the lower at
an
of abdomen. To have toast and
part
co.
tea, continue arrowroot congee. ls< December?No change in her speech, slept, complains that the pain of the uterine region is Lochia free, bowels acted once, urine severe. drawn off again last night, and this mornwas ing ; patient's mother reported that her daughter perspired much during the night. ConTo have a cup of arrowroot at once. and mixture. tinue pill Turpentine stupes, to have toast and chicken broth (or her dinuer.
May
Dr. CUNNINGHAM ON COMMA-BACILLI.
1890.]
2nd December?The patient began to speak last evening, slept, states that she feels easier of the pain of the uterine region, but complains Bowels of pain and distension of her breast. acted once, she passed her urine herself this morning for the first time; skin dry, pulse accelerated. Omit calomel pill, continue mixture twice a day, apply poppy head fomentation to the breast. 3rd December?The patient speaks well, this morning, and states that she feels better of the pain in her breast, and that she has suckled her baby ; bowels regular ; lochia free ; urine normal.
Continue medicament. 7th, Improving, omit medicine.
19th, Doing
well.
Remarks. There are a few points worthy of remark in the above case, the first is the inertia or want ot muscular tor.e of the fundus of the uterus for the purpose of expelling the child ; thereby the second stage of labour had become prolonged, the woman becoming exhausted; this may be attributed to the weak, delicate, and sickly state of the patient. It was prudent on the part of the relations to have the presence of mind to send for professional skill in time whereby there was a chance of saving two lives, the mother and the infant. The operation was resorted to eight hours after the rupture of the membranes. Second, the threatening of puerperal convulsions during the second stage of the labour, and third, the sudden appearance of aphasia which came on immediately after labour, it was only transitory lasting three days?a phenomenon. I have rarely observed it in my practice ; the cause for its appearance, in the present instance it is not easily accountable. Dr. Tanner.is of opinion, thatthe presence of some syphilitic deposit, or any other kind of tumour may cause it. The woman is very fortunate indeed that the occurrence was only temporary, and being unaccompanied by hemiplegia. Dr. Leishman in his Midwifery page 828 observes : " several cases of cerebral embointeresting lism aftei parturition have been narrated by Dr. Hughlings Jackson, Fordy ce. Baker, and others; as in other cases of this lesion, the middle cerebral artery on the left side seems to be the most iiequent, and so we find that aphasia is one of the symptoms occasionally observed. From two cases recently under t|ie observation of Dr. Finlayson in the Glasgow "Western Infirmary it would appear that there may be a repetition of this accident, both of the women referred to, suffered from aphasia, which came on within a few days after labour, and after making a tolerably complete recovery, both were seized after their next labour
139
with a very aggravated and persistent form of the aphasia, in one of the cases the right hemiplegia was extreme, but in the other it was
slight."
In the post partum treatment of the case, there was nothing particular with the exception of aphasia, and the urine was obliged to be drawn off, for three or four days; this was probably owing to paralysis of the bladder, the result of the pressure of the head of the child during the arrest. As very few cases of the kind have appeared in the pages of the Indian Medical Gazette I therefore venture to send the above for record
therein.
