numerous napkins and cloths which were all saturated with it; which blood, by remaining in her body, had she been timeously delivered, would, beyond doubt, have saved her life. I also saw that she was seized almost every minute with sinking turns, that were increasing; which convinced me that she was in far greater peril than she could have been had they not lost the opportunity of delivering her two or three hours sooner, which was both possible and of easy execution; for at that time she had almost the whole of her strength, which she afterwards lost by the continual effusion of her blood. Wishing to know whether it was true that she could not be delivered, I found, upon examination per vaginam, the orifice of the womb dilated, so as easily to admit two or three fingers. Having remarked this, I made the midwife examine her again, in order to ascertain whether the os uteri had been in the same state when the surgeon stated that she could not be delivered; and whether she was still of his opinion: she told me, 'Yes,' and that the parts had remained unchanged ever since he had gone away. As soon as she made this declaration, I perceived her ignorance, and what had been the difficulty with the surgeon. Touching this, I told her of my astonishment that they had both been of such an opinion, as I was of a wholly different opinion-for it would have been as easy for him to deliver her then as now; which I should, in truth, have immediately done myself, could I possibly have commanded my judgment, long vacillating upon this resolution, which, from the loss of all hope from other quarters, I was at last constrained to adopt. What hindered me was, not the prognostic of the surgeon, celebrated as he was, who had persuaded everybody that to deliver her was impossible (for it would seem like rashness to resist the dicta of those who are looked upon as oracles), nor the weakness of the patient; but it was chiefly the quality of the person, who was my own sister, and whom I tenderly loved, that agitated my mind with various passions. For my mind was so preoccupied with seeing her ready to expire before my eyes, from the prodigious waste of that blood that had sprung from the same sources as my own, as to make it impossible for me to come to an immediate resolution and action. This obliged me to send incontinently for the surgeon who had left her so long before, and beg him to return to her house, so that I might show him how easily she could be delivered-and by making him understand and confess that there is no hope on such occasions except in prompt delivery, induce him to operate instead of leaving the mother, as he had done, to despair, and allowing her infant to perish without baptism, which it might have enjoyed had he obeyed the requirements of the art; which are, that if both cannot be saved, we

should at least, try to save the child, if that be possible without doing anything prejudicial to the mother. But he would not come back for all the prayers and solicitations that could be offered; and excused himself by saying that it would be impossible to do anything in such a situation. As soon as I learned all these things, I sent for another surgeon, with whom, had he come in time, I should have concluded in favor of the necessity of the operation, of the possibility of which I could have satisfied him; but, as misfortune would have it, he was absent from home. Meanwhile, at least more than an hour and a half more elapsed, during which the blood was incessantly flowing, and the faintness increasing more and more. Finding myself, therefore, hope less of the aid of the persons I had sent for, I resolved to deliver her myself immediately, for I had not been able to resolve upon it, except in this extreme necessity, for the reasons already given; which, indeed, was somewhat too late for the mother; for, had I been able to command myself sufficiently to proceed to the delivery at my first arrival, there was great reason to hope for her safety, as it afterwards proved as to her child, when I had completed the task in the following man

ner:

"I introduced two fingers into the orifice of the womb, which was open enough to receive them; I then gradually inserted a third, and little by little, the ends of all the fingers of my right hand, with which I so dilated the orifice as to admit the whole hand, which is readily to be done on such occasions, because, as has been already said, the abundant discharge of blood moistens and relaxes the entire womb very much. Having introduced my hand very gently, I found that the head of the child presented, and that the waters were not yet gone off, which obliged me to break the membranes with my finger nails. Having done this, I immediately turned the child so as to draw it down by the feet, which I easily effected, as I shall describe the opera tion in the 13th chapter of the second book. The operation was effected in less time than it takes to count a hundred, and I protest upon my conscience, that I never in my life performed an accouchement (of a preternatural case) with greater ease and expedition, or less pain to the mother, who never complained in the least during the ope ration, notwithstanding she then was quite herself, and knew perfectly well what I was doing. Indeed, she found herself quite relieved as soon as I had delivered her, whereupon the flow of blood began to

cease.

"As to the child, I delivered it alive, and it was instantly baptized by a priest who was in the chamber. The patient and all the bystanders, who were numerous, then perceived very clearly that the

surgeon and midwife who had pronounced it impossible to deliver her, had done so without any good reason.

"The operation was performed in good time to procure baptism for the child, who received it, praise be to God, as I just now said; but it was too late to save the life of its mother, who died an hour after its birth, in consequence of having lost too great a quantity of blood; for she fell into a great swoon, like those she had had previously to the delivery. The flow of blood ceased, it is true, but there was not enough left in her body to resist these frequent syncopes, which she could doubtless have done, had the surgeon, who saw her first, delivered her three full hours earlier, as he could have done, without doubt, as easily as I did it; since which time she had lost, without exaggeration, more than eighty ounces of blood, twenty of which, had it been reserved, would have insured her escape; particularly, as she was a young woman, of a good constitution, free from all disease or inconvenience at the time she was attacked by this fatal accident, which happened, as before said, at eleven o'clock in the morning. She was delivered at seven in the evening; but the operation was unsuccessful for her because she had been drained of blood; she died an hour afterwards, in full possession of her senses, and speaking until the last moment of her existence, which was at eight o'clock P. M."

Convulsions. Among the many grave and alarming accidents that occur to pregnant, puerperal, and lying-in women, the puerperal convulsion is regarded as one of the most dreadful; it never breaks forth without carrying terror among all the spectators, and the scenes exhibited during one of its paroxysms cannot be observed without emotion even by the most experienced and use-hardened physician. There is scarcely any trouble for pregnant women that I would not prefer to witness, rather than this shocking and distracting one, and I say so after an ample experience of almost every possible form of obstetrical horrors.

It would seem that any person conversant with the nature of obstetrical disorders, accidents and tendencies, ought not to feel surprised at the outbreak of a paroxysm of eclampsia in a pregnant woman not as yet advanced to her term, and much less in a woman enduring the pains, terrors and fatigue of her labor, for labor is almost always attended with augmented impetus of the blood's motion, and with those coincident changes in the animal heat, sensibility and irritability I have already discoursed of in a former page. Whether we advert to the changed susceptibility of the pregnant woman, which develops a state closely allied to the hysterical condition; or whether we con

sider the extreme violence with which the blood of a woman in laborrushes along the arteries of the encephalon, we must admit that the brain cannot but be in an excited state and prompt to exert its powers in such a manner as to convulse the whole or part of the muscular system: the activity of the cerebro-spinal system is always propor tioned to the quantity and impetus of the blood circulating in the vessels, and every woman in labor whose pulses become hard, large, frequent and violent, ought to be held liable to be convulsed by the neurosity extricated in consequence of such a circulation. An experienced practitioner is invariably surprised when he observes no augmentation of the blood's motion in a severe labor, for it is a rule attended with rare exceptions, that the heart beats with excessive force, and that the arteries are highly charged and loaded with blood during the pains and exertions of the parturient state. Long protracted pressure of the womb on the parts in the abdomen that may have produced oedema gravidarum, must also in some measure have impeded the downward course of the aortic current, and checked the flow in the emulgent veins. The effects of such impediments are inevitably to cause protracted, habitual hyperemia of the brain and cord, and to fill the vessels of the kidneys, and so interfere with the secerning action of those important organs. Thus is laid the foundations of the double mischief of an over-filled encephalon, and of an engorged or hyperæmic kidney; which is one of the stages of Bright's disease, and which cannot but vitiate the mass of the blood.

When a woman whose blood has become impure by the retention of the principles of the urine within it, and who has had habitual hyperemia of the brain and cord, has safely passed through the perils of parturition, only a few hours are required to wholly remove the encephalic fulness and take away the renal engorgement, and so remove altogether the conditions that had brought her life into peril: even where she may have been seized with eclampsia, and that of the most violent grade, she very soon recovers her health, after the birth of the child; provided some lesion of the brain, the cord, or an internal viscus has not taken place during the violent stages of the convulsions. In such an event, she could not be expected to recover speedily, and where the lesion has been a grave one, perhaps not at all.

The pregnant woman who reaches her term and falls into labor without having suffered from oedema or other results of pressure, will rarely be found to have an attack of puerperal convulsions; while every woman who has swelled feet and legs in her gestation; every woman whose urine, on being tested, exhibits the presence of albu men; all those who complain of headache, transient seizures with

amaurosis, tinnitus aurium, deafness, convulsive twitchings, red and tumid hands and fingers, and all in whose urine casts of the tubuli uriniferi are discovered by the microscope; all such people should be regarded as in danger of convulsions either before, during, or after the labor, and watched and treated accordingly. The omission of such precautions is the real cause why the attacks are so numerous, and the observance of a due degree of vigilance would, without doubt, greatly lessen the ratio of the cases in a given number of parturitions. But no such needful vigilance and no such wise precaution can be expected except a proper understanding is first obtained of the nature, causes and treatment of the disorders of pregnant women.

I shall not repeat, in the present connection, what I have already said at p. 240, on the subject of the pressure and obstruction consequent on it, within the abdomen. I have there and elsewhere said. enough to put the Student on his guard, and teach him that he can, and that he ought to ward off the attack of convulsions, which it is far easier and better to do than to cure it after it has come on. It is far better, I say, to ward it off, because it is impossible to witness a seizure and not fear that some fatal effusion, or some mortal rupture and extravasation will take place in the brain, during the paroxysm. Not, indeed, few are the cases in which a fatal blow is struck at the very onset; so that the woman who feels it, never speaks nor recovers in the least from the moment of the invasion, but dies apoplectic, and sometimes outright.

For some women, to be pregnant is to be in the best possible health, while for others the state of gestation is but a protracted disorder, in which the constitutional irritation is analogous to the hectic state. They are feverish from the beginning, suffer from nausea, cephalalgia, pains in the limbs and trunk; become oedematous, hydræmic, hyste rical; are seized with albuminuria; experience what is called uræmic intoxication; and run the greatest risk of dying in childbed with eclampsia. Every such woman is in the condition denominated by Wiegand convulsibilitat. I have treated multitudes of women affected with this convulsibility, and in most of them I have warded off attacks of convulsion that appeared to me to be imminent, while, in some few, the seizure has taken place in despite of all my vigilance, all my precautions, and my most carefully considered prescription.

I feel very sure that precisely the same sort of convulsions as those that attack pregnant women do affect both men and children, as well as virgins, and no one, I presume, will now deny that the most exquisitely marked examples of puerperal eclampsia do occur, without any discoverable complicity with morbus Brightii or other visceral disorder,