MIDWIFERY. 
rarely dies in tlie fit, though she die from 
convulsion ; she dies in the comatose state 
which succeeds to the fit ; and if vve be sud- 
denly called to a patient in tliis state, where 
we are unable to learn the circumstance of 
the case, and we evidently see there is a 
great fullness about the head, we should im- 
mediately open a vein, and draw blood 
largely, being regulated by the appearance 
of the body and what we are able to learn 
from those around. From twelve to twenty 
ounces may be the extent of the first bleed- 
ing ; if the disease go on, and the os uteri 
do not admit of delivery from its not being 
in the least dilated, the convulsions not 
gone off, and the pulse in such a state as ad- 
mits of it, we should bleed again, and again. 
§ome practitioners have with the greatest 
advantage taken sixty onnces of blocrd in a 
day. A woman in this state will admit of 
divided bleedings very largely. This takes 
off the pressure from the brain, made by the 
blood while in its vessels ; and also the 
chance of its being extravasated. This 
must be done immediately ; then the head 
must be shaved, and a large blister applied 
over the whole cranium. The next means 
of relieving is getting the bowels into action 
as quickly as possible ; first, by throwing 
up a soft soap solution in the form of injec- 
tion, and then by giving a concentrated so- 
lution of some neutral salt with infusion of 
senna. 
If it be a case of convulsions depending on 
irritation, we may certainly do something 
more by the use of opiates ; and here we 
must be limited in the quantity of blood 
which may be taken away. The proportion 
must be small compared with that proper in 
plethora. Eight or ten ounces will be a full 
bleeding; and if it be necessary to take 
more, we may apply leeches to the temples, 
never neglecting the bowels, which must be 
kept very open. It has been directed that 
the patient be put into a warm bath ; but ex- 
perience contradicts its use ; the fits have 
been found to be more violent in it, and the 
patient is liable to bruise herself in it, and 
be otherwise much injured. 
It is an extremely dangerous disease : it 
is impossible for her brain to bear the 
violent pressure of her situation ; opium, in 
cases of irritation, is proper, and should be 
given to the greatest possible extent. With 
this we may join the affusion of cold water. 
This, when resolved on, must not be done 
))y sprinkling a little out of a bason upon 
the patient’s face ; but we must have both 
a full and an empty pail, the patient’s head 
being brought over the side of the bed ; 
and before the fit has come on, w’e may, as 
in other convulsions, detect its approach 
by attending to the intercostal muscles, the 
vibrations of which will warn ns that no 
time is to be lost ; when we should imme- 
diately discharge the whole over the head 
at once. Whenever this complaint occurs 
at or near the'time of labour, it is uniformly 
right to deliver : to dilate the os uteri, and 
deliver immediately. We should deliver in 
all cases where it is practicable ; for this 
is the only enre for puerperal convulsions. 
If convulsions occur some days after la- 
bour, it should be treated as the same dis- 
ease in other cases. 
Rupture of the Uterus. This was for- 
merly considered as a very rare occurrence, 
though it probably happened oftener than 
practitioners were aware of. We have 
many descriptions of sudden deaths in la- 
bour, the symptoms of which exactly cor- 
respond with those known to attend rup- 
tured uterus. It may be divided into two 
kinds, spontaneous and accidental : the first 
happening most commonly in the cervix 
uteri, and the last in any part of the 
uterus. 
.Spontaneous rupture occurs suddenly 
and unexpectedly, and always without any 
warning, and for this reason, that it depends 
on the irregular action of the muscular 
fibres, and all muscular contraction is imme- 
diate. It most commonly happens, that 
when the head of the child is in the cervix 
uteri, the lower segment of the uterus is re- 
ceived into the tipper aperture of the pelvis, 
and the aperture of the pelvis without the 
uterus is opposite to the bones of the head 
within the uterus ; the consequence is, that 
the uterus is pressed firmly between the 
tw'o forces : from the pressure being ap- 
plied in this situation, the longitudinal 
fibres can only contract from the pressed 
circle towards the fundus ; and upon this 
principle it will not tear at the extremity, 
but will tear tfom the part so pressed upon ; 
the rent once made may run in any direc- 
tion. 
Accidental rupture occurs from the action 
of the uterus being violent while the hand 
of the practitioner is within, or the same 
thing may happen fiom pressure of the 
knee or some other part of the child, which 
last is frequently tlte cause. 
The manner in witich the uterus give* 
way in this instance, is exactly a fibre con- 
tractirrg over a pulley, which being a disad- 
vantageous position is liable to be rnptureal 
