PARTURITION. 
Inftances it has become neceflary afterwards to perforate 
the fetal head, and even then the delivery has been ex¬ 
tremely difficult, and ultimately deftruftive to the mo¬ 
ther. But upon the whole, the evidence we at prudent 
poffefs, is more in favour of opening the tumours, wdien 
they contain a fluid, than of any other mode of procedure. 
The firft plate in Merriman’s Synopfis reprefents a cafe 
of an ovarian tumor impeding delivery: it has indeed a 
very formidable appearance ; but the doctor does not 
inform us what mode was purfued, nor with whatfuccefs. 
Lacerated or ruptured Uterus. —The moll fatal accident 
perhaps to which parturient women are liable is rupture 
of the uterus. This occurrence moll ufually takes place 
in protradled labours, w'here the uterine contraction has 
continued for a confiderable time, though in other re- 
fpe6is the labour often appears perfe&ly natural. The lace¬ 
ration occurs in different parts of the uterus ; but its moll 
general feat is near the cervix, the fundus rarely being 
torn. The peritoneal coat of the uterus is fometimes 
ruptured without involving the ftru&ure of the uterus 
itfelf; and, vice verfa, the uterus may be lacerated with¬ 
out the peritoneal covering participating in the injury; 
in which cafes (it is hardly neceflary to add) the fymp- 
toms conne&ed with the efcape of the fcetus into the 
abdominal cavity are not manifeft. 
We are not acquainted with any certain fymptoms by 
which this mournful occurrence may be forefeen ; nor 
is the caufe of it known with precifion. In many inftances, 
however, it is produced by extenfive injuries, as blows, 
falls, kicks, &c. and not unfrequently by the incautious 
ufe of inftruments or by forcible attempts to turn the 
fcetus in utero: it is likewife brought on by tum.ours in 
the vagina, exoftofes, cartilaginous hardnefs of the os 
uteri, or by an unufual fharpnefs of certain proceffes of 
the pelvic bones. Dr. Ramfbotham is difpofed to think 
that a thinning of fome part of the uterus, from undue 
preffure during pregnancy, may be a common caufe ; 
and Mrs. Boivin, a French midwife, mentions that, in a 
woman who died foon after delivery at the Maternite, 
whofe pelvis meafured only two inches and three quarters 
from pubis to facrum, the uterus, at a few lines above 
its neck, in the fituation correfponding with the facro- 
vertebral angle, appeared to be very nearly worn through 
for the fpace of two-thirds of an inch, being in this part 
not above the eighth part of a line (96th part of an inch) 
in thicknefs. The cafes of Denman, Bye, and feveral 
others, fhow alfo the effeft of undue preffure on fome 
projefting point of the bones of the pelvis, in the pro¬ 
duction of this accident. 
The following are the fymptoms of this affeflion.— 
During the continuance of an expulflve effort, the patient 
complains of an excruciating pain at fome particular fpot 
in the abdomen, which file defcribes as much differing 
from common labour-pains, and is fo fevere that it makes 
her fhriek loudly ; it is accompanied by a fenfation of 
fomething burfting internally, and the burthen appears 
to l’ife up from the pelvis into the abdomen ; vomiting 
fucceeds immediately afterwards, and uterine aftion be¬ 
comes fufpended at once, or is gradually rendered weaker: 
fyncope, great proftration of ftrength, coidnefs of the 
extremities, and hemorrhage, occur; refpiration is hur¬ 
ried and anxious; the pulfe finks, is rapid and tremu¬ 
lous, and the patient expires in the courfe of a few 
hours. Sometimes death is quicker in its progrefs; for 
the woman has been obferved to become extremely reftlefs 
after the accident, to gafp and expire immediately : in 
other cafes fhe is deftroyed more flowly by inflammation ; 
and inftances are mentioned in which the fcetus has found 
an exit in procefs of time through the parietes of the 
abdomen. 
With refpefl: to the treatment of this malady, it was 
recommended by Smellie, Denman, and Hunter, not to 
attempt delivery, but truft to the efforts of nature. 
Recovery however fo feldom occurred with this manage¬ 
ment, that it was afterwards thought more advifable to 
Vol. XVIII. No. 1275. 
701 
extract the fcetus; and the favourable refults of fuch 
praftice feem to place the propriety of it beyond doubt. 
The delivery may be effected according to the circum- 
ftances of the cafe, by turning the fcetus and bringing 
down the legs, by means of the crotchet, or by galtro- 
tomy. In the feleftion of thefe methods we mull: be 
guided by the fize of the pelvis, the fize and fituation of 
the child, and by the degree of hemorrhage or contraflion 
of the uterus. 
We lhall infert one curious and recent cafe, which oc¬ 
curred to the obfervation of M. Bertrand, a furgeon at 
Mery-fur-Seine, in France. E. Laurent, 40 years of 
age, having arrived within a fortnight of the completion 
of the ninth month of her eighth pregnancy, ufed fome 
powerful exertions in loading a cart, on the 9th of July, 
1811. During this effort, file fuddenly experienced very 
fevere uterine pains, accompanied with the efcape of 
fome water, and afterwards of blood, from the vagina. 
The pain and hemorrhage ceafed on the patient being- 
placed in bed. This ftate of calmnefs continued until 
the 15th, when the abdomen became tumefied, painful, 
and fymptoms of the prefence of inflammation were de¬ 
veloped. Towards the end of the month, fymptoms of 
extreme debility fucceeded this inflammatory ftate, and 
the patient fsemed to be on the verge of death. At lall, 
a red circular fpot appeared between the navel and the 
pubes, which was foon converted into an efchar fur- 
rounded by a red circle, which feparated on the 13th of 
Auguft, and gave vent to a large quantity of fiocculent, 
puriform, and extremely fetid, fluid ; and then to the 
decornpofed body of a fcetus, which appeared to be of 
the full period. The feverity of the fymptoms foon dif- 
appeared; the ftrength of the patient was reftored ; the 
wound gradually diminifiied, and, towards the end of 
September, perfectly healed. Menftruatioli appeared four 
months afterwards, and has continued regularly ever 
fince. It fliould be remarked, that, on the efcape of the 
foetus, M. Bertrand paffed his left hand into the cavity 
of the uterus, which he could fully explore; and, car¬ 
rying the fore finger of the right hand into the vagina, 
he encountered with it that of the left, which had been 
directed towards the mouth of the uterus. M, Bertrand 
thinks that the infant loft its life at the time when the 
violent exertion of the mother gave rife to the fevere 
pains and the rupture of the membranes ; that it remained 
in the uterus ; and that fome projecting part of its body 
prefling forcibly againft fome point of the uterus, produ¬ 
ced inflammation of that organ, which was communica¬ 
ted to the adjacent parts, and terminated in the efchar 
comprifing the paries of the uterus and the correfpond¬ 
ing part of the abdomen. London Bled. Journal, vol. 
xliii. p. lxxxv. 
A cafe occurred to Dr. Bromfield, of rupture of the 
uterus, where the patient died undelivered ; refpefting 
which, he thought it expedient to make an affidavit, 
which was fworn before Charles Marfh, efq. one of his 
majefty’s juftices of the peace for the city and liberty of 
Weftminfter; declaring, “that he never paffed either of 
his hands into the vagina, or more thau one finger of 
either hand ; and that he ufed no inftrument or force of 
any kind.” On what account this affidavit was thought 
neceflary, from a phyfician of Dr. Bfiomfield’s rank and 
eminence in his profeftion, does not appear. 
The moft extraordinary accident of this fort on record, 
is that related in one of the volumes of the Edinburgh 
Medical Effays, where not only the uterus, but the ab¬ 
dominal parietes alfo, burft, and expofed the fcetus. 
Inverfion or Retroverfion of the Uterus. —This accident 
ufually happens during the enlarged and dilated ftate of 
the uterus, immediately after delivery, and is commonly 
attributable to a hafty and incautious attempt to bring 
away the placenta. It has been fuppofed, that the ex¬ 
ploded praftice of dragging at the funis, to extraft the 
placenta immediately after the birth of the child, was 
the principal caufe of this misfortune ; but there can be 
8 Q no 
