CONTRIBUTION TO THE PRACTICE OP MIDWIFERY.
By P. S. Mootoosamy, G.M.M.C., F.L.S., and O.S.L, Native Surgeon in Medical Charge of the Mannargudi Civil Dispensary and Lying-in-Hospital. second stage of labour, continudays after confinement in a Primipara aged 20. Delivery effected by craniotomy : recovery.?On the evening of the 2nd November 1875, I was summoned to a village 14 miles distant from my station to see a Brahmin female, said to be suffering from puerperal convulsions. On my arrival, I found my patient, a tall, delicate looking young woman, in a comatose state and breathing stertorously, having just had The pulse was weak and frequent and a convulsive seizure. the pupils dilated. I was informed that she was in labour of her first child, the pains having commenced four days previously. The membranes ruptured about 6 p.m., on the 1st
Puerperal convulsions in the
ing for
three
instant, and the convulsions set in some nine or ten hours afterwards. On examination, the head was found firmly impacted in the hollow of the sacrum, and the uterus tightly contracted on the body of the foetus. All uterine action had ceased, and auscultation failed to give evidence of the existence of foetal life ; the passages were hot and dry, and the vulva considerably swollen. For twenty-four hours there had been no action of the bowels and bladder. After the former were relieved by a dose of calomel and croton oil assisted by an enema, and an unsuccessful attempt made to empty the bladder, I proceeded to perform craniotomy, and succeeded in extracting the child with great difficulty, owing partly to the great rigidity of the passages, and in part to the frequent recurrence of the fits. The placenta was found adherent and required detachment. A couple of doses of Tinct. Ergotse in Brandy were administered and good contraction of the uterus secured. The convulsive seizures continued to recur throughout the night, but the intervals became lengthened and the fits were not quite so violent in character. On the two following dajs the patient had several returns of the convulsions, each fit being shorter in duration and less severe than the previous one, and it was not until the fourth day that they ceased entirely and consciousness returned. On the 7th day the patient was slighty feverish from the establishment of the lacteal secretion, and she complained of pain in the mam-
glands. These, however, were quickly relieved by the usual means and she made a good though slow recovery. Remarks.?Cases of puerperal eclampsia are of frequent occurrence among native females, and of those which I have mary
I have not observed that they in one season than another, though the belief appears to be that this complication arises more
witnessed in my were
more
general frequeutly
own
practice,
frequent
in wet aud
damp Beasons than
in the
dry.
Januaey 1,
eclampsia can clearly be obviously be difficult to In the present case, though
in those cases where the
Except
ascribed to ursemic the
trace
NOTES ON INFANTILE DISEASES.?BY F. K.
1877.]
origin
poisoning,
it must
of the disease.
I Was unable to examine the urine from 'want of the means of testing it, still from the appearance of the patient and her
history
as
from her
gleaned
suspect that albuminuria
friends,
had
there
was
no
reason
to
share in its causation,
any
lleilex irritation may have had something to do with it, but. am disposed to believe that this was materially assisted by jnental emotion. I was informed that since .the death of her elder sister some months previously, from what was described I
to me as puerperal convulsions, the patient became very despondent, and when she found that her labour was protracted she appeared to give way entirely. She repeatedly referred to her sister's death, and declared her fears that she also
would die from convulsions.
The fact also that this was her
iirst pregnancy after five years of married life made her anxious as to the result.
May and I such
not mental emotion in this case have been the
of the
cause
eclampsia
I
?
exciting disposed to think that it was, supposition of the possibility of
am
borne out in my by the arguments of Dr. Barnes in his Lumleian
am
a cause
Lectures delivered at the
Royal College of Physicians in 1873. a special proclivity to convulsive diseases in pregnant women, that emotional sensibility is also exalted at the same time, and that the two conditions are mutually convertible^ Dr. Barnes says that emotional affectibility is the measure of convulsive liability." It appears, therefore, possible that in the present instance this emotional sensibility which existed in an extreme and morbid degree, was the immediate cause of the eclampsia; that, in fact, the patient's highly nervous condition found vent in convulsive explosions.
After
out that there is
pointing
"
This
case
further illustrates the amount of mischief which
results from the
ignorance
of the class of women who
practice
midwives among the poor, and also of the evils of caste prejudices. Had assistance been sought earlier when the as
forceps might to the patient As it
saved.
have been
used witli
and
was
anxiety of the tl(e patient being
most
bigotted among objected to my being
the
advantage, much suffering friends might have been of the "Vishnu sect?the
Brahmins?her
friends
strongly
sent for, and it was not until the hustannd, who had been trained in an English school, expressed his determination to make some effort to save his wife's life
that I
nsked to
was
see
her.
mismanagement of parturient women, seeking assistance for them, lead to the loss of life are unfortunately of very common occurrence. As a case in point, I m?v here mention that not long ago I was summoned to a village in the interior of the district to see a female who had been four days in labour. On arrival I found the poor woman in the last stage of exhaustion, and, in fact, she died in a Instances in
which
and delav in
few minutes after I reached the house.
In this
and remediable.
case
the cause of
From
inflammatory action set up after her last confinement there was partial occlusion of the vaginal orifice, the openins admitting only of the introduction of the little finger. How different might difficulty
have
was
been
sought
simple
the termination of this sad in time!
case
had relief been
/*pi
HOGG,
M.D.
By P. S. Mootoosamy, G.M.M.C., F.L.S., and O.S.L, Native Surgeon in Medical Charge of the Mannargudi Civil Dispensary and Lying-in-Hospital. second stage of labour, continudays after confinement in a Primipara aged 20. Delivery effected by craniotomy : recovery.?On the evening of the 2nd November 1875, I was summoned to a village 14 miles distant from my station to see a Brahmin female, said to be suffering from puerperal convulsions. On my arrival, I found my patient, a tall, delicate looking young woman, in a comatose state and breathing stertorously, having just had The pulse was weak and frequent and a convulsive seizure. the pupils dilated. I was informed that she was in labour of her first child, the pains having commenced four days previously. The membranes ruptured about 6 p.m., on the 1st
Puerperal convulsions in the
ing for
three
instant, and the convulsions set in some nine or ten hours afterwards. On examination, the head was found firmly impacted in the hollow of the sacrum, and the uterus tightly contracted on the body of the foetus. All uterine action had ceased, and auscultation failed to give evidence of the existence of foetal life ; the passages were hot and dry, and the vulva considerably swollen. For twenty-four hours there had been no action of the bowels and bladder. After the former were relieved by a dose of calomel and croton oil assisted by an enema, and an unsuccessful attempt made to empty the bladder, I proceeded to perform craniotomy, and succeeded in extracting the child with great difficulty, owing partly to the great rigidity of the passages, and in part to the frequent recurrence of the fits. The placenta was found adherent and required detachment. A couple of doses of Tinct. Ergotse in Brandy were administered and good contraction of the uterus secured. The convulsive seizures continued to recur throughout the night, but the intervals became lengthened and the fits were not quite so violent in character. On the two following dajs the patient had several returns of the convulsions, each fit being shorter in duration and less severe than the previous one, and it was not until the fourth day that they ceased entirely and consciousness returned. On the 7th day the patient was slighty feverish from the establishment of the lacteal secretion, and she complained of pain in the mam-
glands. These, however, were quickly relieved by the usual means and she made a good though slow recovery. Remarks.?Cases of puerperal eclampsia are of frequent occurrence among native females, and of those which I have mary
I have not observed that they in one season than another, though the belief appears to be that this complication arises more
witnessed in my were
more
general frequeutly
own
practice,
frequent
in wet aud
damp Beasons than
in the
dry.
Januaey 1,
eclampsia can clearly be obviously be difficult to In the present case, though
in those cases where the
Except
ascribed to ursemic the
trace
NOTES ON INFANTILE DISEASES.?BY F. K.
1877.]
origin
poisoning,
it must
of the disease.
I Was unable to examine the urine from 'want of the means of testing it, still from the appearance of the patient and her
history
as
from her
gleaned
suspect that albuminuria
friends,
had
there
was
no
reason
to
share in its causation,
any
lleilex irritation may have had something to do with it, but. am disposed to believe that this was materially assisted by jnental emotion. I was informed that since .the death of her elder sister some months previously, from what was described I
to me as puerperal convulsions, the patient became very despondent, and when she found that her labour was protracted she appeared to give way entirely. She repeatedly referred to her sister's death, and declared her fears that she also
would die from convulsions.
The fact also that this was her
iirst pregnancy after five years of married life made her anxious as to the result.
May and I such
not mental emotion in this case have been the
of the
cause
eclampsia
I
?
exciting disposed to think that it was, supposition of the possibility of
am
borne out in my by the arguments of Dr. Barnes in his Lumleian
am
a cause
Lectures delivered at the
Royal College of Physicians in 1873. a special proclivity to convulsive diseases in pregnant women, that emotional sensibility is also exalted at the same time, and that the two conditions are mutually convertible^ Dr. Barnes says that emotional affectibility is the measure of convulsive liability." It appears, therefore, possible that in the present instance this emotional sensibility which existed in an extreme and morbid degree, was the immediate cause of the eclampsia; that, in fact, the patient's highly nervous condition found vent in convulsive explosions.
After
out that there is
pointing
"
This
case
further illustrates the amount of mischief which
results from the
ignorance
of the class of women who
practice
midwives among the poor, and also of the evils of caste prejudices. Had assistance been sought earlier when the as
forceps might to the patient As it
saved.
have been
used witli
and
was
anxiety of the tl(e patient being
most
bigotted among objected to my being
the
advantage, much suffering friends might have been of the "Vishnu sect?the
Brahmins?her
friends
strongly
sent for, and it was not until the hustannd, who had been trained in an English school, expressed his determination to make some effort to save his wife's life
that I
nsked to
was
see
her.
mismanagement of parturient women, seeking assistance for them, lead to the loss of life are unfortunately of very common occurrence. As a case in point, I m?v here mention that not long ago I was summoned to a village in the interior of the district to see a female who had been four days in labour. On arrival I found the poor woman in the last stage of exhaustion, and, in fact, she died in a Instances in
which
and delav in
few minutes after I reached the house.
In this
and remediable.
case
the cause of
From
inflammatory action set up after her last confinement there was partial occlusion of the vaginal orifice, the openins admitting only of the introduction of the little finger. How different might difficulty
have
was
been
sought
simple
the termination of this sad in time!
case
had relief been
/*pi
HOGG,
M.D.
