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I have already announced, in a note to M. Colombat's Diseases of Females, and in my Letters on Woman and her Diseases and Remedies, p. 240, the opinion that there are instances of inversio uteri in which, by means of some power, the processes of which are at present not known or understood, the womb reposits itself. The two cases of such occurrence that I related in my "Letters," and the case now given upon the authority of Drs. Hatch, Beardsley, St. John, and Beers, appear to me to be quite sufficient to establish the facts. I am most happy to have the privilege of laying before my medical brethren the above interesting relation by Dr. Hatch, which appears to me to settle forever the disputed question as to the spontaneous deposition of the inverted womb. I am even convinced that my late esteemed correspondent, Dr. Crosse, of Norwich, who appeared to think such an occurrence quite improbable, must have yielded his full assent to the facts so clearly stated by Dr. Hatch. Mr. Crosse, of Norwich in England, in his valuable work, entitled An Essay, Literary and Practical, on Inversio Uteri, at p. 177, could not agree with me in the opinion that the first two cases here recited are really cases of spontaneous reposition. "It is easier," says he, "to cast a doubt over the reality of these spontaneous recoveries than to remove the obscurity that pervades the subject generally." Dr. C. also hints that I and my friends may have mistaken a polypus for an inversio uteri: his words (note), p. 177, 2d part, are as follows:

"First Case.-The disease dated from her delivery, two years before, and had existed for that length of time, when Dr. Meigs was consulted. He took the greatest pains to discriminate, and remained under the absolute conviction of its being inversion of the womb; several others concurred in the same opinion. Fruitless attempts were made to reduce the part. Four years afterwards she became pregnant. Second Case. Nearly five weeks elapsed after delivery before the patient was examined and the vaginal tumor investigated by the speculum, and also by the hand introduced into the vagina, till two fingers passed within the cervex uteri and reached the limit of the cul-de-sac, enabling the investigator to convince himself that the tumor within the vagina was 'the inverted womb and nothing else.' After a temporary absence, this patient returned, became pregnant, and gave birth to a child. Hence Dr. Meigs concludes that the inverted womb 'may reposit itself in some rare instances.' (Colombat de l'Isère, Dis. of Women, translated by C. D. Meigs, pp. 182-4.) The deficient account of the method of diagnosis in the first case is, in some degree, supplied in the second; but there is still an absence of that minute detail of proceedings which, in the present day, is alone calculated to convince the skeptical reader.

It may be asked, if we suppose in either case there was polypus, and not uterine inversion, 'What became of the polypus?' Perhaps it may be answered, that it is more easy for a polypus to be separated and thrown off than for chronic inversion of the uterus to reposit itself spontaneously. Whilst the question remains undecided, and further evidence is needed, we have only to take care that the right rule of practice prevails. Velpeau, one of our best authorities on chronic inversion, remarks: 'Des faits de ce genre ne doivent être considérées que comme d'heureuses exceptions; il n'est pas aucun practicien sensé qui oserait compter sur de pareils résultats.' (Leçons Orales de Clin. Chir, ii. 427.)"

It ought not, perhaps, to expose me to a charge of excessive confidence in my own perceptions and judgment, if I should say that in both the cases referred to by Mr. Crosse, I took the greatest pains to make the discrimination; that I have treated many cases of uterine polypus; and that I have practised as an accoucheur, and been largely engaged in treating the diseases of females, for many years past. Under such circumstances, and supported by the coinciding opinions of Drs. Moehring, Hodge, and Warrington, I aver that no mistake was made. I am now fully confirmed in my belief by Dr. Hatch's case, which seems to me to preclude all cavil as to the question.

Mr. Crosse cites Velpeau's words, that "facts of this kind may be perhaps regarded as the happy exceptions to a general rule; but there is no intelligent practitioner who would dare to rely upon such results;" and Mr. C. adds: "If we subtract all errors, and admit only the well-authenticated cases, it may still be remarked that spontaneous replacement is too rare an occurrence to have any influence upon the correct rule of practice, viz., the effectuating by art the reduction of partial inversion of the womb in all its different degrees."

These remarks are just and sound. Yet as cases do occur in which, from the lateness of the detection of them, or from other causes, the reduction is found to be impossible, it is a most important and consolatory reflection, that there remains the hope of a spontaneous replacement, while we are guarded against the danger of making a discreditable prognosis. There is certainly very little hope for a woman affected with irreducible inversion of the womb, except in this very case of exceptional hope, which I have endeavored to establish, and which, I think, ought not to be gainsaid after the testimony in its favor now given. Moreover, there is very little risk that any person worthy the name of Physician would ever desist from every reasonable attempt at chirurgical reduction, on account of any degree of confidence he might indulge in a possible spontaneous replacement of the inverted

womb. So that I am not liable to any charge of advising my reader to desist from all reasonable attempts at repositing the womb, in order that he may indulge the mere hope of a spontaneous repositing of the inverted organ.

I have given a conclusive case from Dr. Hatch, of Connecticut. The Student who will do me the favor to turn to the case at p. 616, will see not only that the woman recovered spontaneously, but that, like the patient of Dr. Moehring, in this city, she afterwards had a child, as also happened to Dr. Levis's patient. Mr. Crosse's doubts as to my correctness affect me the less, since I have acquired (July, 1851) a copy of Daillez's paper on inversion, a paper in which the spontaneous reposition is clearly made out in several instances. Baudelocque, a careful person, admitted it, and the case of Bourcharlatte (Case 34), p. 107, proves it, as in that instance the womb was suddenly reposited after a fall, although it had remained inverted from 1782, when it occurred, until 1790, when, as before said, it was instantaneously reposited, in consequence of a fall. I adhere, therefore, to my opinions, which are, 1st, that we should try to reposit; and 2d, if we cannot, then we may hope for a cure by spontaneous reposition.

CHAPTER XIX.

CHILDBED FEVER.

THERE is a violent and dangerous disorder, usually known in the world as Childbed fever, to which all lying-in women are liable, which is often fatal, even in the sporadic forms; while the alarm created by the announcement of its outbreak is greatly increased whenever the malady happens to be prevailing as an epidemic. During epidemic prevalence of childbed fever, not only are those women who may have been recently delivered regarded as being in a perilous condition, but even those who are pregnant, and not yet advanced to the last stage of their gestation, are looked upon as persons placed in extremely critical circumstances.

It is not wonderful that such alarm should be excited among pregnant and parturient women and their friends, for it is well known that childbed fever destroys more women than all the other diseases and accidents of parturition put together. A physician cannot long practise Midwifery without discovering that a constant and wise vigilance is necessary to obviate the causes of such attacks, and cure the patient who has been unhappily seized with it. Scarcely any form of dangerous disorder is more insidious in its approach, or more rapid in its development when once its terrific train is set in motion; a development so rapid that the loss of a few hours, at the commencement, renders all after interposition fruitless and unavailing. Not a few of the victims perish within twelve hours, and some even within six hours after the first manifestation of the symptoms. This is one reason why an accoucheur, in full practice, can never feel entirely at ease with respect to women recently confined under his care; and happy for his patients, if his vigilance never sleeps; else there might be prepared for them a rapid and fearful destruction, whose first signal being unperceived, should baffle all his efforts and skill, too late applied.

If these observations are just, then the Student of Medicine ought to consider himself, in all honest conscientious views of duty, bound

to give to this subject a careful and even anxious attention; for it is a subject by no means fit to be studied without earnestness, nor cursorily. With it are connected many important principles, that seem of little value as to the matter in general, but which, when considered as relative to the causes, progress, and cure of our disorder, are of the highest importance. There are many good and scientific physiological physicians, who do not apply their general physiology to the elucidation of those mysterious appearances that are discovered in the course of a violent and fatal childbed fever. But the Student ought to be not only a scientific physiologist, but so practically familiar with the laws of life, and its phenomena, as to be able at once to understand and solve the curious riddles that are presented in childbed fever, in its various and complicated, or even in its simple forms.

I have said that there are curious riddles, or mysterious phenomena, in the disease now under consideration; and, I suppose, no one who shall go over the field of inquiry and observe the scandalous discrepancies and inconsistencies of our writers on the subject will cavil with me for saying so. Diseases that are clearly understood, and methods that are proved to be salutary and successful, unite all voices in the proposition as to their nature and cure; but, in our disorder, the utmost latitude seems to have been given to the imagination, so that a complete distraction of the professional mind appears, in the command of this one to regard it as a fever-of that one, as an inflammation-of another, as synocha or typhus; to bleed-not to dare to bleed-to salivate to rely on opium-on ipecacuanha, on turpentine-on purgative drugs, on saline draughts; and so, of every possible suggestion of treatment, until the Student, confused and baffled in his groping after some sure foundation to rest on, gives up the search for truth in despair, and resolves to wait until the conflict arises, and to do as best he may. Yet all this confusion, disorder, and disagreement exists not in the disease, but only in physicians themselves: the disease is one, the writers and talkers are legion, each one having a thought of his own. Doubtless there is a truth of the matter, and what we want is that very truth; which, if it could be once mastered, would clear our art of this discreditable warfare of opinions upon a subject in medical practice, than which there cannot be one more interesting to us, whether as scholars merely, or as ministers of health unto many confiding friends.

The Student ought to resolve to make himself familiar with all these disputations, to the end that, at last, he should, if possible, come to some fixed and clear views of his own: but, in doing this let him first strip off every prejudice, and present his mind a rasa tabula on

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