formed one, and that in our own case the danger would be less on account of the known capacity of the organ. Be it so-but the argument is a felo de se; for it goes to show that it is not demanded by Mrs. E., but only by the child.

Has the child claims? Yes! but the claims of the mother are paramount. Is it demanded as referable to the gratification of an anxious desire to have a living offspring? That is a holy and righteous desire. God grant it may be satisfied; but the function of the surgeon and accoucheur appertains to the health of the patient; the happiness of the patient is the gift of God. The surgeon cannot lift the veil of the future; and if he could, he would, perhaps, be even more reserved than he is now as to the institution of attempts, whose object goes beyond his true vocation. Let him adhere to his vocation, which is fulfilled when he preserves or restores the health of his clients. The mother is his client in the paramount degree.

Let us essay to set in order some of the reasons for waiting until labor shall begin spontaneously in this case.

1. She has given birth to one living child.

2. She has had one unassisted delivery.

3. She has had children of enormous magnitude.

4. There is great reason to suppose, even if it be not absolutely true (as I believe), that the fault is in the nature of the uterine fibre, and not in the form or dimension of the pelvis. If so, then no operation is admissible.

5. She has recovered well.

6. She has been delivered of a child beyond the average size, in a labor of only four hours.

7. No man knows whether the child now in utero is above the ave rage size.

8. If there is a breech, knee, or shoulder presentation, what should we gain by violence done both to the mother by the operation, and to the child by hurrying it into the struggle before it is completely developed and prepared for the strife.

9. Who knows if it be or be not a twin pregnancy? if it be a twin pregnancy, what vain, what poignant regrets over a step signally false !!

10. Possibly, she may spontaneously enter on labor at eight months and a half.

11. Do we know that it has not already a prolapsed cord?

12. Suppose the operation done, and the lady attacked with the chill so common in the case-suppose her the victim of a metritis-with a living orphan child? cui bono!

But, my dear E., I will not continue to string together objections; they are all comprised in the single fact that she is a fit subject for a forceps operation, if that should be demanded by the circumstances. This fact is an unanswerable one, in my estimation. It is true, I could set forth reasons of a moral complexion for refusing intervention, but I shall refrain considering them, as equally obvious to you and to me. I pray you, however, in this matter, not to misapprehend me; I have no doubt of the morality of the induction; nor of our legal right to do it, under the diploma given by the authority of a State. I look upon that diploma as an authority given to me by State commissioners, and, in the name of the State, constituting me judge, to act at my peril under the indications of an upright and enlightened conscience and judgment. But the spirit of my commission is caveat as to all rashness and irregularity of proceeding.

I hope the effect of this letter may be to lead you to submit with readiness to the voice or will of the consultation, which was not given in favor of the induction. We admit we do not know, and no man can know, what the result will be; but I trust you will believe that, should it be fortunate, I shall greatly rejoice in your mutual happiness; if it should be unhappy again, I shall sympathize in your distress. I shall in any event steadily adhere to this, viz.: that it is better to suffer the ills that Providence sends for our chastisement than, by rash and ignorant measures of precaution against them, make them tenfold more intolerable.

I am, &c.,

*

The following notes were furnished to me by my friend, who was present at the birth of this ninth child. The history of the labor and the measurements of the foetus, as well as its weight, serve, I think, fully to confirm my opinions in opposition to the operation that was proposed in the case.

NINTH ACCOUCHEMENT.

August 29, 1843.-Eight months and one-quarter (or one-third at most) of utero-gestation.

Labor commenced about seven P. M., a short time before reaching home after a long ride. Quarter past seven.-Reached home, and went immediately to bed; pains recurring, at intervals of ten or fifteen

minutes, until eight o'clock, when they became more frequent and of shorter duration.

8 P. M.-Dr. Hodge arrived; found os uteri size of half a dollar. 9 P. M.-Vs. 3xxv; Dr. Meigs arrived during the operation.

20 minutes past nine.-Gave 40 grs. Dover's powder by enema. 45 minutes past nine.-Gave 35 drops laudanum, by mouth.

50 minutes past nine.-Pains recurring; membranes protruding; os uteri fully dilated.

55 minutes past nine.-Pains on and off; intermitting; uterus relaxes after pain, which is unusual in her case.

10 P. M.-Pains every few minutes.

10 minutes past ten.-Cramps in left leg during pain.

20 minutes past ten.-Anodyne effects decided; patient complains of feeling sleepy; pains continuing regular and natural until

5 minutes before eleven-when a strong pain came on, with bearingdown efforts.

11 P. M.-Good pain; head descending rapidly; membranes ruptured.

5 minutes past eleven.-Child born; no accident or artificial interference; weight seven and one-quarter pounds, dressed.-Male. Bi-parietal diameter 3.

Head. Occipito-frontal 4,6%.

(6 -mental 5.

Bi temporal 3.

In the only case in which I have ever been desirous to bring on a premature evacuation of the womb, I could not obtain the consent of the woman to its performance, yet I have had a good deal to do in consultations relative to the cases of this kind that were under the care of my professional friends and correspondents. In all those in stances that have presented of late, I advised a resort to Kiwisch's method, or to that of Braun-and I now feel convinced that Braun's is to be preferred to all others.

Kiwisch's method consists in using a douche of water, directed by means of a proper apparatus against the os and cervix uteri, and I believe it will be always found that, if a strong current of water is daily thrown by a proper douche apparatus into the vagina, the os will dilate and the ovum be expelled. This mode of bringing on premature labor, however certain it may be, and safe in its results, is less expeditious than the new method of colpeurysis. Both of these, however, are much to be preferred to the old method by puncture of the membranes, because in both of them, there is good reason to expect

that the waters of the amnios will not be discharged until in an advanced period of the labor, when the neck of the womb, and possibly, the vagina is sufficiently dilated.; For a premature child, there is always considerable risk of dying soon after its birth, or while the mother is in labor, and its risk is greatly increased by a too easy discharge of the waters. As neither Kiwisch's upward douche, nor Braun's colpeurysis are chargeable with such an objection, they should be preferred to the method by puncture.

By the douche method, labor may be brought on in three or four days; by Braun's colpeurysis, it is found that about four hours suffice to dilate the os uteri sufficiently to provoke good labor pains, that end in discharging the foetus and secundines very much in the same way as they are expelled when premature labor comes on from some constitutional or other cause independent of violence. I now refer the Student back to page 253 for an account of Braun's colpeurysis, with a figure of his colpeurynter, and shall make no further remarks on the subject here, as I have sufficiently explained the use of the implement at the above mentioned page.

CHAPTER XVIII.

INVERSION OF THE WOMB.

INVERSION of the womb is an accident in which the uterus becomes turned inside out. Inversion is incomplete or complete: when it is incomplete, the vault or concave of the fundus has fallen down into the cavity of the body, in that of the neck, or that of the vagina. When inversion is complete, the vault of the fundus has come quite out through the os uteri, followed by the corpus and the cervix. The womb, soon after delivery, is too large to remain wholly inside of the pelvis when it has become completely inverted. Therefore, I say that, when the recent inversion is complete, it comes entirely outside of the genitals. In this case the womb is inside out, as a stocking is that has been turned inside out in drawing it off the foot.

The accident is a rare one. Yet the consequences of it are so terrible, that no accoucheur ought in his practice to lose sight of the possibility of its occurrence, nor fail to guard his patient against it.

When a womb remains relaxed or uncontracted after delivery, no attempt ought to be made to take away the after-birth by pulling at the navel-string. Should the placenta be still adherent to the fundus uteri, tractions exerted on the cord would tend to draw forth the afterbirth, which might, perhaps, drag the fundus uteri along with it, and thus turn the organ inside out, or invert it.

A patient who has just been delivered, is sometimes still affected with tenesmus that provokes her to bear down. This is not safe; since, if the vault or fundus of the womb should happen to be relaxed, the straining of the parts above it, might turn the vault inwards into the womb-like the bottom of a junk-bottle-and, when once thus partially inverted, such straining would turn it quite inside out. The Student ought to read Article IV. of M. Leroux's work on Uterine Hemorrhages, to learn how clearly the eminent Dijon accoucheur has expressed sound opinions on this subject, and become aware of the risks to which patients in labor are exposed, when conducted by those who do not fully understand the subject of inversion.