8th, 10 A. M. Rested well all night; secretion of milk natural; the infant was put to the breast during the night; pulse 100: skin pleasant, moist; tongue slightly furred, moist; urine by catheter eight ounces; wound was examined without removing dressings; suppuration is commencing; there has been throughout a slight oozing of bloody serum; she is this morning removed to another bed. 2 P. M. Pulse 92; secretion of milk increased so much as to cause some uneasiness to her; breasts are directed to be well. drawn. 8 P. M. Pulse 92; breasts relieved by drawing; urine by catheter ten ounces. "9th, 10 A. M. Slept soundly all night; appears very comfort able; pulse 97; skin pleasant, moist; secretion of milk abundant; lochia natural; urine by catheter eight ounces. 6 P. M. Pulse 96: skin moist; abdomen flaccid, free from all pain or tenderness; no flatulence; urine by catheter eight ounces; directed the mixture carb. potasse to be omitted; she had taken it occasionally, on account of flatulence, since the evening of the 6th; to-night, is permitted to take arrowroot gruel; has been restricted to small portions of barley-water until this time.

"10th, 9 A. M. Slept comfortably; having some return of flatulence, took two doses of potash mixture in the course of the night; relished gruel; external organs were washed with weak wine and water, much to her relief; pulse 104; skin moist; urine by catheter eight ounces. 1 P. M. Pulse 100; wound dressed for the first time; it extends from half an inch above the pubis to one and a half inches from the umbilicus; adhesion has taken place at the upper and lower ends; discharge slight, bloody, dark-colored; at the upper end of the cicatrix from former operation, on the right side of the incision, it is slightly inflamed, of an erysipelatous appearance, and ulcerated, for the space of two inches; I removed a stitch from this point, which seemed to be a source of irritation, also one from the upper end; washed the parts and applied fresh adhesive strips, leaving a sufficient space for the free escape of pus; a piece of lint, spread with cerate, and bandages were then applied; she complained of no pain or fatigue. Bowels not having been moved since the operation, an enema of warm flaxseed mucilage is directed; breasts, which are somewhat troublesome, to be well drawn; the child would nurse, but from the mother's position it is difficult and fatiguing; consequently, we rarely put it to the breast, having from the first had a wet-nurse for it. 6 P. M. Pulse 100; skin pleasant; no pain; all her symptoms are most favorable; urine by catheter ten ounces; enema not having operated, another to be administered.

"11th, 9 A. M. Slept well, but in consequence of some pain in

the evening, caused by the enema (which operated freely), she took two doses of morphia solution; pulse 96; tongue less furred, moist; urine by catheter eight ounces; abundant secretion of milk; no unfavorable symptom; slight dark-colored discharge from wound; fresh cerate applied; asks for increased diet; is to be allowed the soft part of six oysters and a biscuit, in addition to the gruel. 6 P.M. Pulse 96; urine by catheter six ounces.

"12th, 10 A. M. Rested well; took one dose of morphia; pulse 98; skin pleasant; has passed water twice through the night without the catheter; the wound looks well, healing; inflammation about the old cicatrix much diminished; I removed three more stitches, and applied fresh adhesive strips to lower parts of it; diet, milk, eggs, and oysters.

"13th, 10 A. M. slept well; wound

fresh dressings.

Pulse 96; no pain; skin natural; tongue clean; looks well; removed the last suture, and applied

"15th, 10 A. M. Has slept well for the last two nights; pulse 96, soft and pleasant; skin and tongue natural; countenance good; very cheerful; spirits throughout have been excellent. Wound looks well; adhesion perfect above and below; is filling up rapidly; inflammation of right edge subsided; suppuration moderate, lighter color; lochial discharge has ceased. This morning, for the first time, she complains of her position, which has been altogether upon her back; upon examination, a small slough (size of a cent) is discovered upon the sacrum; inquiry had frequently been made upon this point, but the fear of being moved induced her to conceal the pain and soreness until this time; her position is now being changed to the side, hips being protected by adhesive plaster; a poultice of bread and milk to be applied to slough; diet as before. 5 P. M. Much more easy since change of position; pulse 92; has for the last two days suckled her infant.

"17th, 10 A. M. Pulse 84; bowels were opened yesterday by an enema; slough separating, superficial, does not complain of it; wound looks healthy; suppuration slight.

"25th. Has been very comfortable since last report; no pain or tenderness; pulse 88; wound nearly closed, a small opening merely remaining about the top of the old cicatrix; the discharge from it very slight; bowels being confined, she is requested to take ol. ricini 3j; to-day is permitted to sit up in the bed.

"We have conceived it unnecessary to head each daily report, 'Met Drs. Meigs and Gibson,' we having continued to meet regularly during the first week; after which time, Dr. Gibson saw her occasion

ally, during the progress of the case, as convenience or inclination dictated; Dr. Meigs continued in regular attendance some time longer. "December 26. Mrs. R. has continued perfectly well; soon after date of last report, was permitted to leave her bed; the slough on the back soon separated, and caused but little inconvenience; the incision in the abdomen has healed, with the exception of a small fistulous opening, which is occasionally touched with lunar caustic; her diet has for some time past been generous.

"February 21, 1838. The fistulous opening heretofore noticed continued a source of annoyance till the 10th inst., since which time it has been entirely closed; the cicatrix is now complete, and looks healthy.

"Remarks. Our patient had a better 'getting up' than many females after an ordinary accouchement; her sufferings after the operation were slight; indeed, in twenty days from the day of its performance she sat up; and, for some days previous, constantly nursed her infant. The adhesions connecting the uterus and abdominal parietes in front were so extensive, as almost to have permitted the performance of the operation without necessarily opening the peritoneal sac; very much diminishing its dangers. It may be worthy of notice that, nine months subsequent to the former operation, during lactation, the menstrual discharge returned, healthy and natural in every respect. During the progress of the case, the patient was visited by many of our medical friends.

"The infant has grown finely, not having had an hour's sickness since birth."

CHAPTER XVII.

INDUCTION OF PREMATURE LABOR.

IN cases of deformed pelvis in which the reduction of the diameters has not gone too far, the child may be rescued, if it be delivered at some period between the attainment of viability and the completion of term, if it shall not have become already too large to pass through the contracted passages.

The foetus in utero is understood to be viable or livable at the completion of the seventh month; at that period the foetal characters of the heart have begun to approach towards those in the respiring child, and the pulmonary vesicles have become so thoroughly developed, that most of the children born at that term are free from the danger of continued atelectasis pulmonum. For a woman with a bad pelvis— with a pelvis reduced, for instance, to three inches in its diameter—it is very good fortune to be prematurely delivered, provided the gestation have not gone beyond the eighth month, for the head of the child at that time is both small and very ductile. The observation of cases in which women with deformed pelves have given premature birth to living children, led at length to the adoption of operations, by means of which the child is ushered into the light, at times supposed to be so happily chosen, that the disproportion between the foetal head and the contracted pelvis should not render its escape impossible.

Dr. Denman, in the tenth section of his twelfth chapter, treats of the propriety of bringing on premature labor, and the advantage to be derived from it. The first information which he obtained upon the subject was derived from Dr. C. Kelly, who informed him that, about the year 1750, there was a consultation of the most eminent medical men at that time in London, to consider of the moral rectitude and the advantage to be expected from the practice; which, it appears, met the general approbation. The first case in which it was deemed necessary, was terminated successfully by Dr. Macauley. Dr. Macauley afterwards performed it several times, and sometimes with success;

and Dr. Denman relates the case of a lady of rank whom he attended with Dr. Savage, in consultation, in which the operation proved successful.

Dr. Lee, in his Clinical Midwifery, 2d ed. p. 81, relates the history of the operation in the labors of Mrs. Ryan, æt. twenty-one, primipara: she lost the child after an embryotomy operation. In her second labor, Dr. Lee opened the membranes at the eighth month: he perforated the head. The third labor was brought on at seven months and a half; the feet presented; child lost. Fourth labor, induced at seven months; footling; child dead. Fifth labor, induced at the seventh month; the child born alive, died in sixteen days in convul sions. Seventh labor, induced at seven months and a half; the feet presented; child lost; great force required. Eighth labor, induced at seven months and a half; feet presented; child dead. Ninth labor, induced at the seventh month; the feet presented; child lost. Tenth labor, membranes perforated at the seventh month; child lost. Eleventh labor, induced at the end of the sixth month; child dead. Twelfth labor, induced in the seventh month; child dead. Thirteenth labor; at the end of the sixth month, labor induced; child lost. Fourteenth labor, seventh month; child extracted alive, but soon died. Fifteenth labor, seventh month; child lost. I have cited this case of extraordinary perseverance, on the part of Dr. Lee, as much to show the resolute energy of that gentleman, as to show what may be ex pected in many of the cases of induction of premature labor.

It is not to be doubted that the operation is legitimate, and that he who does it properly acts within professional rules and usages; but, inasmuch as every premature labor furnishes some just grounds of apprehension, both for the parent and child, I am clear in the belief that well-understood motives alone can justify the accoucheur who performs it. A woman may lose her child in one labor, and so on throughout a succession of labors, from faults not at all relative to the state of the pelvis. A lady was under my care in this city, who, in sixteen pregnancies, had given birth to only one living child; she subsequently gave birth to two children, of which the first was born a little past the eighth month, whereas the gestation of the last son continued until the close of the ninth month. There was never suspicion of the least fault in the dimensions of the pelvis. A lady of this city, out of eight children, lost seven in labor. It was proposed to her, previous to the birth of her ninth and last child, to submit to the induction of premature labor. I had been long convinced that the cause of the death of the children, in this person, was a cause relative to the action of the uterus and not to the resistance of the pelvis, because