LECTURES ON THE THEORY AND PRACTICE OF MIDWIFERY,

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No. 233. LONDON, SATURDAY, FEBRUARY 16. [1827-8. LECTURES ON THE THEORY AND PRACTICE OF MIDWIFERY, DELIVERED AT GUY’S HOSPITAL BY DR. JAMES BLUNDELL. LECTURE X.1X. OUR remarks on floodings generally being brought to a close at our former meeting, I proceed, Gentlemen, this morning, to en- large a little oia those different species or varieties of flooding, which you are likely to meet with at the bed side, dividing them into those which are occurring in the first three or four months of pregnancy, and those which make their appearance in the last three or four,-the earlier and later floodings, as they may be called. Before, however, 1 enter on the con- sideration of the earlier floodings, it may not be amiss, on the very threshold of our subject, to premise a few observations on the appearances of those substances which, in this part of gestation, are found to come from the uterine eavity. I may observe, then, at the outset, that rarely, yet occasionally, as this preparation shows, the whole ovum is expelled from the uterus entire ; in shape and bulk like a pullet’s egg, containing a cavity of appear- ance immediately to be described,with liquor, and sometimes a foetus not bigger than the garden bean. More frequently, however, disruption precedes the expulsion of the ovum, the parts of which escape in suc- cession ; and first the liquor escapes, and then the embryo, if this be not already vanished, to be followed ultimately by a fleshy mass, which constitutes the most im- portant pait of the whole structure, well exhibited ; to view in this preparation-glass. In this fleshy , when washed and im- mersed in clear water especially, you find a hollow of bumpy (tubercular) surface- smooth—polished—invested with a semi- transparent glistening membrane of pearly appearance, through which the dark red of the structure over which it lies, may be ob- scurely seen. With this fleshy mass, which at first glance resembles a clot of blood, membrane is marginally connected, float- ing in the water, and forming, in the entire condition of the ovum, a part of the cavity in which, as in the hollow of the egg, the embryo is lodging. Before I proceed to the next appearance of the ovum, it may be proper to remark, that in the earlier months the fœtus is ot very small size, compared with the bulk of the secundines, as these preparations clearly demonstrate ; so that the fleshy mass, with which the embryo is in connexion, may be large as half the hand, when the embryo itself is no bigger than a single joint of the little finger. Now ;for the ovum to come away in a third manner, is by no means very uncommon ; the foetus, it may be, being first ex- pelled, or not appearing at all, while the secundines follow by pieces, one portion after another, till the whole is discharged from the womb. To those who are accus- tomed to inspect the ovum of the earlier months, if the structure be in ordinary con- dition, it is by no means difficult, on exami- nation, to determine whether a part only, or the whole, be away ; but those prac- titioners who have paid but small attention to these matters, are liable to deceive them- selves with the persuasion, that the uterus is completely evacuated, when, in reality, a part of the ovum still remains in its cavity. The embryo is so small at this early period, and the secundines are so large, that, at first glimpse, one half of them seems pro- portionally of bulk more than adequate to the foetus. Beware, therefore, of falhng into error here-beware of presuming that the uterine cavity is empty, when a portion of the secundines still remains; for this portion lodging in the hollow of the uterus, may keep up the drainings as effectually, as if the ovum lay there entire. Again.-Hereafter, you will understand more clearly, that the ovum, composed of two parts, the one the foetal portion, made up of the embryo, en-

Transcript of LECTURES ON THE THEORY AND PRACTICE OF MIDWIFERY,

Page 1: LECTURES ON THE THEORY AND PRACTICE OF MIDWIFERY,

No. 233.

LONDON, SATURDAY, FEBRUARY 16. [1827-8.

LECTURES

ON THE

THEORY AND PRACTICE OF MIDWIFERY,

DELIVERED AT GUY’S HOSPITAL BY

DR. JAMES BLUNDELL.

LECTURE X.1X.

OUR remarks on floodings generally beingbrought to a close at our former meeting, Iproceed, Gentlemen, this morning, to en-

large a little oia those different species orvarieties of flooding, which you are likely tomeet with at the bed side, dividing theminto those which are occurring in the firstthree or four months of pregnancy, andthose which make their appearance in thelast three or four,-the earlier and later

floodings, as they may be called.Before, however, 1 enter on the con-

sideration of the earlier floodings, it maynot be amiss, on the very threshold of oursubject, to premise a few observations onthe appearances of those substances which,in this part of gestation, are found to comefrom the uterine eavity.

I may observe, then, at the outset, thatrarely, yet occasionally, as this preparationshows, the whole ovum is expelled from theuterus entire ; in shape and bulk like a

pullet’s egg, containing a cavity of appear-ance immediately to be described,with liquor,and sometimes a foetus not bigger than thegarden bean. More frequently, however,disruption precedes the expulsion of theovum, the parts of which escape in suc-

cession ; and first the liquor escapes, andthen the embryo, if this be not alreadyvanished, to be followed ultimately by a

fleshy mass, which constitutes the most im-portant pait of the whole structure, wellexhibited ; to view in this preparation-glass.In this fleshy , when washed and im-mersed in clear water especially, you find a

hollow of bumpy (tubercular) surface-

smooth—polished—invested with a semi-

transparent glistening membrane of pearlyappearance, through which the dark red ofthe structure over which it lies, may be ob-

scurely seen. With this fleshy mass, which

at first glance resembles a clot of blood,membrane is marginally connected, float-

ing in the water, and forming, in the entirecondition of the ovum, a part of the cavityin which, as in the hollow of the egg, the

embryo is lodging. Before I proceed tothe next appearance of the ovum, it may beproper to remark, that in the earlier monthsthe fœtus is ot very small size, comparedwith the bulk of the secundines, as thesepreparations clearly demonstrate ; so thatthe fleshy mass, with which the embryois in connexion, may be large as half thehand, when the embryo itself is no biggerthan a single joint of the little finger.Now ;for the ovum to come away in a thirdmanner, is by no means very uncommon ;the foetus, it may be, being first ex-

pelled, or not appearing at all, while thesecundines follow by pieces, one portionafter another, till the whole is dischargedfrom the womb. To those who are accus-tomed to inspect the ovum of the earliermonths, if the structure be in ordinary con-dition, it is by no means difficult, on exami-nation, to determine whether a part only,or the whole, be away ; but those prac-titioners who have paid but small attentionto these matters, are liable to deceive them-selves with the persuasion, that the uterusis completely evacuated, when, in reality, apart of the ovum still remains in its cavity.The embryo is so small at this early period,and the secundines are so large, that, at

first glimpse, one half of them seems pro-portionally of bulk more than adequate tothe foetus. Beware, therefore, of falhng intoerror here-beware of presuming that theuterine cavity is empty, when a portion ofthe secundines still remains; for this portionlodging in the hollow of the uterus, maykeep up the drainings as effectually, as if theovum lay there entire. Again.-Hereafter,you will understand more clearly, that theovum, composed of two parts, the one thefoetal portion, made up of the embryo, en-

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closed in a delicate membranous bag, coveredwith a fine shag ; the other, the maternal,consisting of the fleshy mass, which, in goodmeasure, encloses both the embryo and itsreceptacle, corresponding with the placentaof the full-grown ovum of nine months.Now, it sometimes happens, that the fœtalpart of the ovum is expelled alone on oneday, while the placenta, or remaining’ por- ition of the ovum, escapes from the uterus alength of time afterwards, an interval of un-certain duration, sometimes of a few hours,sometimes of a few days, being interposed;the woman during the whole term havingall the symptoms of miscarriage, as, by thepresence of the placentar portion of the

ovum, the distention of the uterus is keptup. Now, in cases of this sort, you aremore exposed to deception, because, theembryo, with its membranous cyst and li-quor amnii coming away, as tiie preparationexhibited shows, it has, to the inexperienced,the appearance of a complete ovum : the in-experienced only, however, can be deceivedin this manner ; for if your eye have beenaccustomed to the inspection of miscarriagesin the earlier months, the want of the pla-centar part of the structure must appear ob-vious at once.

For women to conceive of three, four, orfive ova at once is very rare ; but the occur-rence of twins is by no means infrcquent.Now, in miscarriages, sometimes a sin-

gle ovum may come away, another, or thegreater part of another, still remaining be-hind in the cavity of the uterus. Not tomention that we now and then meet withcases in which, together with a healthyovum, there forms in the womb a fleshymass, (a mole, as it is popularly called,) inwhich no traces of ovum are deseernible,the whole of the ovum being expelled, andthis mass remaining behind in the uterus,and, as in ordinary miscarriage, keeping upthe discharge of blood. In difficulties of thiskind the prudent and very circumspect prac-titioner, the Volpone of his profession, willprobably soon detect the nature of the case ;but those who are rash, or have seen little,may be again deceived, inferring, with toomuch certainty, a thorough evacuation of theuterus, because a complete ovum is come away.The error nnt nf speculative nature is to

be deprecated in a practical view; for thebleeding from the uterus continuing, yetnot being understood by the practitioner,it is probable that he may not have recourseto the more judicious means for its ..suppres-sion. ’When the case is ambiguous, exami-nation is the only diagnostic on which wemay with certainty rely.

In miscarriages, it is by no means un-common to see no traces of the embryo;dead, perhaps, and dissolved, in the liquoramnii, like sugur in water, or food in the

gastrio juices. Occasionally we find partsof the embryo only, the head iiioreespe-cially ; and it well deserves commemon.

tion, that now and then the embryo dying,and melting perhaps in the second mouth,the secundines are retained, and continueto grow till they acquire the bulk of thesame parts in a nine-month ovum, so that,to the astonishment of the unpractised,there at length issues from the womb alarge placenta, with its membranes andwater, without.the foetus, which might 1esupposed to tenant them. When, too, theovum dies in the earlier months, it may beretained till the close of pregnancy, thefoetus, without growing or decaying, remain. ing quietly in the cavity of the womb till,in the seventh or eighth mnuth, perhaps,labour pains occurring, the ovum is at

length expelled, but not of the bulk which,from the age of the gestation, we shouldhave anticipated. Hydatids sometimes formin the ovum, and, if 1 may be allowed theexpression, devour it; sometimes a partonly becoming converted into tlieir sub. !stance, so that they lie embedded and con.cealed in the placentar structure; some-

times the whole-or, with the exception ofa few vestiges, the whole-being consumed,so that in place of the ovum, nothing butthese animalcules remain in the uterus.-Sometimes they form a cluster large enopgbto fill a washand-basin, or a vessel morecapacious ; sometimes they are altoge6erof much smaller bulk. Much bleeding ac-companies their expulsion when theirgrowth has been great, nor is the ftoodmgalways sparing when their bulk is muchsmaller. While adverting to the changeswhich the ovum undergoes before its ex-pulsion, 1 must not forget to remind you ofthose shapeless masses, membranous or solid,before mentioned. Of these it may be ob-served further, that sometimes there areseveral, more generally they are single ; likethe ovum itself, they vary much in theirbulk, sometimes rot larger than tlae puflet’segg ; occasionally large as the fist, thechild’s head, the child itself, or even largerthan this. Masses like these may give riseto symptoms similar to those, produced byordinary miscarriages, and they are bestmanaged on the same principles .? otherflooding cases.And thus much then respecting the diffe-

rent substances which escape from the ute-rus in the earlier and middle months. Thevarious points worthy of attention are wellillustrated by the series of preparations onthe table before you, and which I now pro-ceed to circulate. ,

For this preparation of the ovum I amindebted to my friend Mr. Sterry ; you seeit entire, in size and form, like the fowl’segg ; the preplratiou which follows it also

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of the earlier weeks, at first glance presentsan appearance like a clot of blood, andshows how needful it is to order the nurseto preserve, for the inspection of the ac-coucheur himself, all solid substances whichmay pass from the vagina, in order thathe mav decide whether or not the ovum become away.The third preparation shows the interior

of this apparent clot, and exhibits excel-

lently well the various characters of the

cavity in which the foetus lodges; thesmooth membrane, the bumpy (tubercular)surface, with its glistening, pearly, yet lividred colour. These glasses contain speci-mens of the foetal portion of the ovum, onlya few weeks old ; consisting of a bag cover-ed with fine’ shag, filled with water, inwhich the embryo floats. On careless, orinexperienced inspection, such substancesmay seem to form entire ova, but in truththey constitute but a small part of thewhole structure. In the glasses now putforward yon see the fleshy masses, bigas one-third, or one-half the hand, andwhich consist of the fleshy parts belong-ing to the preceding. Here is a fostus of thesize of three months; it remained in thewomb till the seventh. Here is an amor- I

phous mass, which came from the uterusafter a four-month ovum had been expelled,and the miscarriage was supposed to becomplete-much bleeding attended. Thisfine cluster of hydatids came from the ute-rus, as you may know by their being all ofthem like grapes appended to a stalk ; youmav see the remains of the ovum on which

they have been feeding’. This engraving isof a placenta and membranes of the size ofseven or eight months, matured in theuterus, after the embryo, of small size pro-bably, was dead and dissolved in the liquoramnii ; the secundiness of great bulk com-ing away without their usual occupant, thefoetus, to the great surprise of the accou-cheur. At small expense you may makefor yourselves preparations of the sub-stances which come from the uterus, andI recommend you, when in practice, by allmeans to do this, as it is desirable thatthese appearances be well known to theaccoucheur. From ten to fifteen glasseswould probably contain all the specimensyour practice might require. As you ex:amine the different preparations which arenow passing round, do not omit to noticethe smallness of the foetus in the earliermonths, and the largeness of the secundineswith which it is connected.

Management of Flooding in the earliermonths.—When floodings occur in the earliermonths, if the patient is robust and strong,and full of blood, and if she be leftin a greatmeasure to her own resources, the prac-titioner prescribing on general principles

for occasional symptoms, she will in generado well ; and very satisfactory it is to thelyoung accoucheur to remember this, as,like an anodyne, it may soothe and tran-

quillize the mind when he is sitting at

the bed-side of the patient. Without, however, meaning to alarm you needlessly, it is

proper I should remark, that women donot always recover, even in the earliemonths, and certaiply not always in themiddle parts of pregnancy, when the dis-

charges become larger, more especially ifthe patient have flooded much in precedingmiscarriages, and have thus been much re-duced in blood and flesh. Under these earlierbleedings, in some few instances, women sinkfrom inanition, and still more frequently,when they escape with life, the tenor of thegeneral health becomes greatly impaired, sothat for months or years together, they la-bour under the cachexia produced by bleed-ing ; dying’, perhaps, at last, of hydropic, en-teric, or other affections. As, therefore,sometimes, though rarely, they are attend-ed with danger, and as they always impairthe health and create much uneasiness and

anxiety to the patient and her friends, thedifferent varieties of earlier flooding are wellworth the study of the accoucheur ; and Iproceed, therefore, to remark on them.Of miscarriages in the earlier months,

there are some remarkable for the rapidityof their progress ; in the morning the pa-tient is well; in the evening, after afright,long walk, or after the ordinary bustles andfatigues of her establishment, sometimes,too, without any obvious cause whatever,she is suddenly seized with an eruption ofblood from the uterus ; fainting follows-then a rally-then pain-then expulsion ofone of those substances just demonstrated ;the process, perhaps, being completed in thecourse of one or two hours. The evacuationof the uterus is followed bv a contraction ofits cavity, and a cessation of the bleeding,the patient recovering completely in thecourse of a few days, so that scarcely a traceof the accident remains. Of all the formsof earlier flooding, this is most to be desired.More generally, however, it happens in away more harassing to the practitioner,that the expulsion takes place in a gradualmanner; induced, as before, by some im-prudence, or arising, it maybe, without anyobvious cause. At first, perhaps, a fewounces of blood are lost, and then the pa-tient, keeping herself cool and composed,the haemorrhage ceases, returning, however,when she rises, and begins again to stir

about ; and thus it may be, bleeding at onetime and free from hæmorrhagy wholly or ingreat measure at another, she gradually sinksinto a state of inanition, becoming pale, cold,fainty, so that she is compelled at last to

confine herself to the sofa or the bed.

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Meanwhile, as the bleedings proceed, painsbegin to form, cutting, grinding, sawing, atfirst, then forcing, and, beyond all furtherdoubt, parturient ; and more blood flowsfrom the uterus, and, sooner or later, thecontained substances come away under theforms before shown and described. Days,weeks, sometimes one or two months, ormore, may be occupied by this process, andthe total quantity of the blood lost may belarge, the constitution suffering much inconsequence, and, in some few cases, deathitself being the result. ,

There is yet a third variety of haemorrhagewell deserving of notice, I mean the he-

morrhagy, whether rapid or tardy, underwhich you have merely a partial evacuationof the uterus. A woman is seized, perhaps,with an eruption of blood from the womb,and a substance mistaken for the ovum comes

away, so that you are assured by your pre.decessor in the case that the uterus must havebeen thoroughly evacuated. Notwithstandingthis, however, you learn that the hemorrhagydoes not cease, and, from this time, it maybe for weeks together, the patient is moreor less liable to discharges of blood from theuterus, and by and by there issues fromthe womb an offensive odour, as if some-

thing were decomposing there. When theuterus is in this way partially emptied,there may be a retention of half the ovum ;there may, too, be a retention of a twin, anaccident, however, which in these cases Inever myself witnessed ; or, as before ob-served, there may be a retention of somefleshy mass in the nature of a mole lying inthe uterus, and keeping up the bleeding ;and this I have myself seen. Now in these

perplexing cases, the grand point is to de-cide, whether the womb is empty or not-and to this end, when floodings prove obsti-ate, you should always bear in mind the re-collection, that it is to something retained inthe uterine cavity, that this obstinacy ismost probably to be ascribed ; nor shouldyou suffer yourselves to be lightly drivenfrom this opinion by the declarations ofthose who have preceded you in the manage-ment of the case. A suspicion of this kind,prepares the mind for furthur investigation.In midwifery, as in medicine generally, toomuch faith is a fault. Doubt—investigate—the more the better-truth here has no fears.Well, then, suspecting that the ovum is par-tially retained by the uterus, if the health bemuch shaken by the continuance of the

bleeding, you must of course determine thisvery important point. Now that the wombis not emptied, you may sometimes know,by examining the ovum which has been

expelled, and finding that it is not complete.And if you have been in the habit of exa-

mining preparations of this kind, and par-ticularly if you have been in the habit of

making them, as recommended, acquiringan experienced eye, you may sometimesdecide at a glance whether or not the ovumbe complete, and, therefore, whether, with.out retention of any part, the whole of ithave been expelled from the uterus.

Again, you may further judge, whetheror not some substance be retained in theuterus, by ascertaining whether, after thereputed evacuation of the contents of theuterus, the patient have still remained ob-noxious to floodings, cutting or forcingpains, or those smells offensive to the sense,resulting from animal decomposition. Now,if there is a pertinacious discharge, and.if,more especially, with this discharge, painsor fœtor are concurring, there can, I think,scarcely be a doubt, that there is somethingstill remaining in the cavity of the uterus.Should the urgency of the case, however,demand decision, and should the point stillremain in doubt, provided your. hand liesmall, and your manual skill considerable,you may generally at once determine thequestion by the introduction of the iiageninto the uterus,-an operation, however, notwithout its dangers, to which, therefore,you ought not wantonly to have reeoutse,and from which, in the commencement ofpractice, it is better to refrain. In per-forming this operation, as the vagina is veryrelaxed, the left hand, if small,-,may begently deposited in its cavity; and then thebladder being empty, you may place, theright hand over the uterus above and behindthe symphysis pubis. This done, the firstand second finger of the left hand beingpassed onward from the vagina, apto.thevery fundus of the uterus, which, hy .thecounter-pressure of the right hand.. is cau-tiously pushed downward and backwardupon their tips, the cavity may be exami4edwithout any difficulty. Should you find a solidsubstance in the uterus, you may, at thetime, take it away. Though, in the earliermonths, you may pass your hand intotlievagina, you must not even think of.passingthe entire hand into the uterine cavity., I hadalmost added, that the very thought is

enough to bruise and tear the parts. If youare, from former experience, fit to performthe operation, which I have been de.scribing, you will find no difficultyinexe.cuting the different parts of it. Withoutthe safetv, or, at all events, the entire futurehealth of the patient demand the operation,it ought not to be done. It is an evil justi-fiable only when a remedy for ,one stillgreater. If you want skill, have recourse tosome one more dexterous. Dilators of theos uteri, and extractors to remove the ovum,have been contrived ; they are more likelyto do harm than good. Iron has no feelingfor you or for the patient.There is one other variety of flooding in

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the earSer months, which it may be well tomention here ; I mean the ’flooding whichcontinues after the womb is in reality tho-roughly emptied, of which I have seenseveral instances. In the third month,perhaps, the whole ovum comes away; but,instead of shrinking in the ordinary man-ner, the womb still remains very large-very lax-very vascular; the patient, of con-sequence, continuing obnoxious to the bleed-ing. It is by examination only, as beforeexplained, that this case may with certaintybe made out, by passing into the uterinecavity two of the fingers of the left hand,and counter-placing on the fundus uteriabove the symphysis pubis the fingers ofthe right, the condition of the womb maybe clearly ascertained. Remember, how-ever, what was before stated, that to inter-nal examinations of this kind you oughtnever to have recourse, unless the life orthe entire health of the patient requirethem. Generally, in the earlier months,women will do very well, provided you letthem alone. And thus much, then, respect-ing the more interesting varieties of earlierHooding. The rapid, the tardy ; the flood-ing’, in which some portion of the ovum, orsome other solid substance, is retained inthe womb. And the floodings, lastly, inwhich, though the uterine cavity is empty,thebaemorrhage continues nevertheless; thewomb being large, lax, and full of great ves-sels, with its vascular orifices unusually re-laxed.

Management of the Earlier Flnodings.-Afterthe general observations already at largepremised, the management of the earlierfloofings may he compressed intn few words.

Ifa woman, in the earlier months, is labour-ing under a Hooding of one or other of thefour varieties, no obvious danger attending,the less you actively interfere, the better.The patient should be a-bed, quiet, and cool;the bowels should be opened, the system,if feverish, should be refrigerated ; and coldshould be applied topically, and, in largerdoses, perhaps, lead should be administered,or the vagina should be obstructed, pro-vided the discharges, copious and pertina-cious, seem to require it. But if you findyour patient laboming under a dischargemore copious and dangerous, and if there isreasonable cause for believing that life, orthe tenor of her future health, may be indanger, practices more vigorons than thosejust enumerated may be required. In theserarer exigencies, besides the remedies ordi-nary in such bleedings already detailed atlarge, it behoves you to consider whetheryou may not have recourse to some of thedeobstruents formerly commended, (ergot,for example,) in order to accelerate the ex-pulsion of those substances lodging in theuterine cavity, keeping up the dischage,

The ergot I have sometimes tried, accordingto the rules formerly prescribed, and withthe greatest advantage. From idiosyn-crasy, or other causes, should the ergot re-main inert, it would, too, be for considera-tion, whether you might not manually in-terfere, emptyiug the uterus by that actionof the fingers, already explained and demon-strated. Such interference, however, be itremembered, is always an evil. Violencewill bruise, tear, and kill. To remove theovum, however, when it lies not in thewomb but the vagina, is often both safe andproper, in both varieties of flooding. Yet,when the bowels are open, often of itself itcomes away.

I will not suppose it necessary to remind

you, that in the latter floodings, when thewoman, without further discharge, lies in astate approaching to asphyxia, to disturbthe , clots by manual operations may bedeath. I should despair of teaching youprudence and caution, could I imagine thatthis principle, so lately pressed home uponthe attention, were already effaced from themind ; and yet I have my misgivings : me-mories are sometimes aqueous. Remember,that even in earlier gestation, if the womanhave lost much blood, and if she be in astate of deep fainting, it is unsafe at thistime, in any way, to disturb the clots. Lether lie and rally. Assist her by othermeans than manual operations about the

vagina. Transfusion may be necessary.-Then, when she is thoroughly established,when the bleeding shows a disposition toreturn, when, the womb being empty, thedrainings of blood still obstinately continue,vaginal operations may be proper enough.

In continued drains fiom the uterus,when emptied of its contents, besidesthe more obvious and general practices,there are two deserving especial notice-mercurial action, and the injection of theuterine cavity. Though not, I tIUst, be.sotted with an overwrought opinion of thepowers of this valuable mineral, I thinksome cases have fallen under my notice, inwhich, whatever its action, the cessation ofthe drainings might be reasonably attri-buted to a mercurial action in the system.Do not, however, I entreat you, without re-flection, headlong, go and salivate your pa-tients. A slight soreness of the mouth isall I would recommend, and this as an ulti-mate remedy. It would be better for thepersonal charms, and, I am sure, sometimesbetter for the health of our patients, if someof our blue pill and calomel were converted,into looking glasses.

The injection of the uterine cavity withastringent fluids, I learned entirely from myvalued relative Dr. Haighton. Its due per-formance requires an accoucheur ; for it isnot into the vagina, but the womb, that the

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fluid should be thrown. Twice, or oftener,in the day, the fluid may be thrown up.Begin with a scruple of alum to a pint ofwater, increasing the strength according tothe effect produced. The blood is some-times consolidated in the uterus by the ac-tion of the alum, and may, to the greatalarm of the patient, be expelled with painslike those of partuiition ; and for this, sheshould be prepared. Though not preparedto assert that this practice is wholly with-out danger of inflammation, I never, myself,saw any serious ill consequences resulting.Women are now living who have, 1 think,been preserved by this remedy; but it shouldnot be used without need.

The grand errors which you are likelyto commit in managing the earlier floodings,are, I think, the following. When tyru:,and young soldiers in midwifery, you areapt to be too soon intimidated by the sightof blood. Perturbations are always unde-sirable in a practitioner ; be it remembered,of the earlier bleedings, that they generallydo well ; that thought is an excellent ano-dyne. Again, if rash and resolute, you mayfall into a second error, in some measurethe result of the preceding; that, I mean, ofneedlessly thrusting your hand into the

vagina, and your fingers into the womb.,Remember, I have told you, nor can I re-iterate it too often, that you never can enterinto the womb without risk ; and who, ofcommon humanity, will incur that risk un-less overborne by a paramount necessity?Now, in floodings of the earlier months,such necessity but seldom exists ; of con-sequence, but seldom are your active manual

operations required. It may, it is true, besometimes necessary to use the hand; buta meddlesome midwifery is bad. Beware.Remember the principles formerly prescrib-ed. The use of instruments to dilate the mouthand neck of the uterus, or to take awaysubstances from its cavity, I dislike; in ayoung accoucheur, it is certainly an error.That dilatation of the os uteri can never be

proper, I dare not assert. Now and thenthe finger may be used as a dilator; nowand then the forceps may be used to take4way the substance contained in the uterine

cavity ; but these anomalous cases are sorare, that, not to bewilder the mind, it iswiser, perhaps, to consider them as no-

thing. Beginners, at least, and such 1 ad-dress, ought not to be perplexed with them ;and on the whole, for you, I think, it isbetter to take the chance of evil arisingfrom the rejection of these practices, thant’ie chance of the still greater evil whichmay result from their adoption ; for thecasesin which these practices may be need-lessly and injuriously attempted are innu-

merable ; but those in which the rejectionof them may be attended with ill conse-

quenccs, are indeed few. A meddlesomemidwifery is bad. " Bene ascolta chi ."To suppose the uterus to be empty wtxait is not, is another grave error. ltecollectthe diagnostics stated to you in the coareeof this morning, and you may, I thiak,generally keep clear of this mistake. Nor,perhaps, is it unnecessary to guard your-selves against an error the converse of theformer-that of imagining, because the

bleeding is pertinacious, that somethingmust necessarily be retained. In the moredoubtful cases—time or examination mustdecide. Of the latter floodings we treat at our next meeting.

LECTURES ON CHEMISTRY,

BY

PROFESSOR BRANDE.

Delivered at the Royal Institution of GreatBritain.

LECTURE XXVII.

On Potassium, Potash, Nitrate of Potash, alld’ Gunpo2oder.

THE decomposition of potassa, and the

discovery of potassium, were effected sconafter the development of electro-chemicalscience., and I have before had occasion tomention to you how the electric poles actin the decomposition of the metals.

It was scarcely credited at first, when SirHumphrey Davy announced that soda andpotash had metallic bases, and it was notuntil two years after, when in the Croomanlecture he detailed the process which ledhim to that conclusion, that the statementobtained general assent. He obtained themetal potassium by submitting caustic pot.ash to the action of Voltaic electricity, andthe metal was slowly evolved at the nega.tive pole upon the platinum capsule. i3yoperating with great care, Sir HumphreyDavy was enabled t:; ascertain the proper-ties of these metals ; he found that theywere different from all other mc-tals in cer:tain respects ; that by their union with OIY’gen, soda and potash were formed; and thusanalytically and synthetically the truth ofthe new discovery was established. Bythis ’process, however, only very minutequantities of the metal could be obtamed;and Gay Lussac and Thenard, reasoningupon the constant elevation of the at-

tractive power of bodies for oxygen btheat, thought that they might find some