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NO.259. LONDON, SATURDAY, AUGUST 16. [1827-8. LECTURES ON THE THEORY AND PRACTICE OF MIDWIFERY, DELIVERED AT GUY’S HOSPITAL BY DR. BLUNDELL. LECTURE XXXV. Delivery after the Death of the Mother. You are not to suppose, Gentlemen, that as soon as the life of the mother be- comes extinguished, the life of the fcetus is extinguished also; for it is a well-ascertained fact, that children will continue to live in utero for minutes, or even half an hour, after the maternal circulation is stopped. When the death of the mother creeps on her gra- dually, whether from bleedings or other causes, the chance of saving the child by removal from the body of its deceased pa- rent, is exceedingly small ; nor is it unlikely in these cases, that the foetus dies before its parent; but where the death of the mother occurs in consequence of apoplexy, or some sudden accident incident to the most vigo- tous health, the probability that the fcetus may survive the mother is much greater. Whatmay be the longest time that the child may continue to live in the liquor amnii, after the circulation of the mother is stop- ped, is a very interesting problem, well deserving of your consideration. In the country, more especially in a farming dis- trict, you may have an opportunity of mak- ing your observations on the sheep or cow when with young ; and after death takes place, whether by accident or intentionally, it would be easy to observe, in these cases, how long a term afterwards the fœtus is ca- f’1ble of resuscitation. Facts are not want- ing hich may encourage us to hope, that !-e child, within the body of the deceased parent, may live even for a considerable time. To Mr. Moseley I am indebted for I the history of a heif’er which, in the end of its pregnancy, died in consequence of some I accident in a farm yard ; in about three quarters of an hour afterwards it was flead and embowelled, during which operation it was observed, that there was some little motion in the uterus ; this led to closer in- , spection, when, on laying open the abdomen and uterus, the calf was taken out in a state of suspended animation, from which, in the course af a few hours, it became completely resuscitated. Thus, then, Mr. Moseley’s statement, which, I trust, is to be relied upon in all its parts, furnishes us with an interesting example of the prolongation of the life of the foetus for three quarters of an hour after the vitality of the parent was become extinct. It sometimes happens that a ioetns is atill-born, and in that condition it mayre- main dead, to appearance, for twenty, thirty, or forty minutes, or even for a longer time than this. Now, while it is in this still condition, there is no obvious respira- tion or c:rculation, yet, nevertheless, though it is in a state very nearly approximated to that of a person after death, it is now and then very unexpectedly resuscitated. I have myself resuscitated a child that had been lying in this state, without any ob- vious signs of active life, for more than twenty minutes together; and Mr.Tomkins, of Yeovil, in Somersetshire, a gentleman formerly of this class, gave me a case in which a fcetus, after lying still for more than an hour, as measured by the watch, was nevertheless resuscitated by the artificial respiration ; and, as Mr. Tomkins is a very accurate observer, I can rely on his state- ment with more than average confidence. Now if a foetus lies in thin way after birth, apparently dead for an hour, to be resusci- tated, however, by artificial respiration, I think it is not unreasonable to hope that a foetus might remain equally long in utero, without, however, getting beyond the reach of resuscitation ; if by the Cesarian opera- tion, or otherwise, it could be brought for-tli, so as to secure a trial of the remedies which I , shall presently enumerate. To be short, then, in the present state of our facts and know- ledge, we may reasonably hope, if a child be taken out of the uterus within half an hour, or an hour after the death of the mother, and
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Page 1: LECTURES ON THE THEORY AND PRACTICE OF MIDWIFERY,

NO.259.

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

LECTURES

ON THE

THEORY AND PRACTICE OF MIDWIFERY,

DELIVERED AT GUY’S HOSPITAL BY

DR. BLUNDELL.

LECTURE XXXV.

Delivery after the Death of the Mother.You are not to suppose, Gentlemen,

that as soon as the life of the mother be-comes extinguished, the life of the fcetus isextinguished also; for it is a well-ascertainedfact, that children will continue to live inutero for minutes, or even half an hour, afterthe maternal circulation is stopped. Whenthe death of the mother creeps on her gra-dually, whether from bleedings or other

causes, the chance of saving the child byremoval from the body of its deceased pa-rent, is exceedingly small ; nor is it unlikelyin these cases, that the foetus dies before itsparent; but where the death of the motheroccurs in consequence of apoplexy, or somesudden accident incident to the most vigo-tous health, the probability that the fcetusmay survive the mother is much greater.Whatmay be the longest time that the childmay continue to live in the liquor amnii,after the circulation of the mother is stop-ped, is a very interesting problem, welldeserving of your consideration. In thecountry, more especially in a farming dis-trict, you may have an opportunity of mak-ing your observations on the sheep or cowwhen with young ; and after death takesplace, whether by accident or intentionally,it would be easy to observe, in these cases,how long a term afterwards the fœtus is ca-f’1ble of resuscitation. Facts are not want- ing hich may encourage us to hope, that!-e child, within the body of the deceasedparent, may live even for a considerabletime. To Mr. Moseley I am indebted for Ithe history of a heif’er which, in the end ofits pregnancy, died in consequence of some I

accident in a farm yard ; in about three

quarters of an hour afterwards it was fleadand embowelled, during which operation itwas observed, that there was some littlemotion in the uterus ; this led to closer in-

, spection, when, on laying open the abdomenand uterus, the calf was taken out in a stateof suspended animation, from which, in thecourse af a few hours, it became completelyresuscitated. Thus, then, Mr. Moseley’sstatement, which, I trust, is to be relied

upon in all its parts, furnishes us with aninteresting example of the prolongation ofthe life of the foetus for three quarters ofan hour after the vitality of the parent wasbecome extinct.

It sometimes happens that a ioetns is

atill-born, and in that condition it mayre-main dead, to appearance, for twenty, thirty,or forty minutes, or even for a longertime than this. Now, while it is in thisstill condition, there is no obvious respira-tion or c:rculation, yet, nevertheless, thoughit is in a state very nearly approximatedto that of a person after death, it is nowand then very unexpectedly resuscitated. Ihave myself resuscitated a child that hadbeen lying in this state, without any ob-vious signs of active life, for more than

twenty minutes together; and Mr.Tomkins,of Yeovil, in Somersetshire, a gentlemanformerly of this class, gave me a case inwhich a fcetus, after lying still for more thanan hour, as measured by the watch, wasnevertheless resuscitated by the artificialrespiration ; and, as Mr. Tomkins is a veryaccurate observer, I can rely on his state-ment with more than average confidence.Now if a foetus lies in thin way after birth,apparently dead for an hour, to be resusci-tated, however, by artificial respiration, Ithink it is not unreasonable to hope that afoetus might remain equally long in utero,without, however, getting beyond the reachof resuscitation ; if by the Cesarian opera-tion, or otherwise, it could be brought for-tli,so as to secure a trial of the remedies which I

, shall presently enumerate. To be short, then,in the present state of our facts and know-ledge, we may reasonably hope, if a child betaken out of the uterus within half an hour,or an hour after the death of the mother, and

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more especially if the mother have perished that has a heart of flesh in his bosom, by a sudden and violent death, that the life have firmness sufficient to perform his of that child may be preserved. Some three rations under such circumstances’ Whoor four years ago, a woman, in the end of could look on the dying eyes of his patient,her pregnancy, crossing a street near this without suffering the knife to drop from hisHospital, was run down by one of the stages; hand ? Who would himself like to he dis-the wheel of which passing over the body, turbed in such a moment? As long as mendivided the liver into two pieces, death are surgeons, surely surgeons may continuefollowing in the course of a very few to be men ; and while they make it theirminutes afterwards. This poor creature was duty to subject their feelings to their reatnw,brought into the Hospital, and Mr. Green, doubtless it is still their duty to act underwho chanced to be going round at the time, that moderated influence of the feelingsgave it as his opinion, that the Caesarian which gives the last finish to the mmtydtt-operation ought to be performed. I was ac- racter. I like the sentiment of the livelycordingly sent for, to give a little obstetric Figaro, " Elle a raison, ma mere; eile aassistance, when, within thirteen minutes raison, raison, toujoursraison! Alaisaccct.from the last respiration of the deceased, dons, maman quelque chose a la nature; Mthe abdomen was laid open ; and the child en vaut mieux apres."was taken out. within fifteen minutes fromthe last respiration, The lungs were in-flated by means of the tracheal pipe-myprincipal resort, the warm hath also beingafterwards tried ; in thirteen minutes more,the child first began to breathe a little, andthe umbilieal chord began to act ; and byperseverance in this method, the fcetus wascompletely resuscitated ; it lived for a day.or two, and would probably have been liv-ing still, had it been more judiciously ma-naged by those to whose care it was com-mitted. Should you be called, then, to acase in which the parent had suddenly de-ceased but a short time before, it is tlrenhighly probable that the foetus is alive ; andshould motion be perceived in the abdomen,theie can then be no further doubt, and, ofcourse, removal must be made the subject ofdeliberation. Now there are two ways inwhich, after the death of the mother, the childmay be taken away; the one is by makingan opening into the abdomen with a razor,or any other convenient instrument, this me-thod, on the whole, being the shortest andthe best; the other turns on the introductionof the hand into the uterine cavity, and theabstraction of the fostus by the operation ofturning. This operation may be- easily per.formed here, as the passages may be dilatedwith more force and celerity, provided themother be really and thoroughly dead ;though even in these cases, such is my strongdislike to obstetric violence, that I wouldnot emplay a greater degree of effort thanis absolutely necessary in order to get thefoetus away. Arte, non vi. And here letme observe, that it is only when the womanis dead beyond all doubt and controversy,that deliveries in’ these wretched cases

ought, I conceive, for one moment to bethought of. Who that has a heart of flesh inhis bosom, could coolly sit down in a realcase to argue for the advantage to be derivedto the fcetus from the performance of theCaesarian incisions, before the maternal lifeis totally and beyond all doubt extinct Who

Of Delivery and latter Gestation, in conjunctionwith Pregnancy.

In the end of pregnancy, you will somf.times find inflammations taking place in thethorax, abdomen, or head, more especiallyof the thorax and abdomen. If those in.flammations are unattended with any ex.

traordinary symptoms, which probably t1f.Vwill be, you should treat them precisely i)tthe same manner as you would an inflam.mation in which there is no pregnanet;because, though it may be true your re.medies, and more especially large bleedinasor purgings, may not altogether suit thepregnant condition, yet, nevertheless, whereyou have inflammation of the thorax or ab.domen, it is absolutely necessary that sCthinflammation should be subdued. It is to beremembered, however, that where there ;san inflammation going forward, and where a

, great deal of blood is taken away, not very un.commonly miscarriages and floodings occur;

nor is it to be forgotten, that during the ab.straction of the placenta and tbe membranes, further and large quantities of bloodmay be discharged from the uterus, which,with the previous venesection, may sir.kthe patient, at least, unless transfusion beinterposed. Three cases of inflammation inthe end of pregnancy I have had occasion tosee ; two of those cases did very well, and iuthe third, in which the inflammation super-vened but a short time before delivery,the inflammatory action was completely sub-dued, but in a few days afterwards partu.rition commenced, a good deal of blood waslost, and ultimately, as my informant tellsme, the lady sunk.You will sometimes find, what I have seen

myself, an inflammation concurrent wichparturition ; perhaps inflammation beii,-iwith delivery, or it may supervene after i’.eprocess is begun. When delivery is comingon, and there is inflammation in the ahdo-men, if you do not perceive that the abdomi-

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nal inflammation is aggravated by the la-hour, meddlesome midwifery being bad, Iwould not have you to interfere. On theother hand, however, if it is clearly obviousthat the labour is hurrying the inflammatoryaction, then the more promptly delivery isteminated the better. If the head is withinthe reach of instruments, you may endeavourto accelerate the delivery by the use of the Iierer or the forceps, or, in some rarer cases,by the perforator ; or, if the head is abovethe brim, then that undesirable operation ofturning must be adopted, and by it the foetusmay be brought away.

It may not be amiss to note here what Ithink I stated before, I mean, that wheretromen have spasmodic and inflammatorypams, about the lower part of the abdomenmore especially, they are mistaken some-times for the pains of parturition. That

they are not the pains of parturition, weknow by their seat, by the tenderness ofthe parts, by their wanting the ordinaryregularity of return ; that they are the painsof parturition may be safely inferred, whenwe find, on examination, that the os uteri isbecoming more and more dilated, thatduring the pain the membranes are tense,and lax during the absence of pain ; or, thatthe head bears down on the tips of theringers during pain, and recedes during theabsence of pain. And by these character-istics it is that I myself, in general, judge.

Of Delivery, or latter Predmnancy, in conjunctionwith Fever.

In the end of pregnancy, or during de-livery, it sometimes happens that fevers

supervene ; and, on this variety of disease,it may be now proper to add a few remarks.When fever occurs in the end of pregnancy,if the attack be severe, it is not improbablethat the expulsion of the child may takeplace; and for this accident, therefore, youought to be prepared. So long, however,13 there are no peculiar obstetric symptomsoccurring, so long it is unnecessary youshould interfere ; and even if the deliveryshould supervene, I think the process ought Ito be conducted on the general principles ofmidwifery. I need scarcely repeat what 1have so often asserted, I mean, that a med-dlesome midwifery is bad, and this beingadmitted, it follows that, in these cases offever, the mere concurrence of the diseasewith the end of gestation, is, in itself, novalid argument why you should interpose.Should there be a concurrence of any otherargent symptom, which delivery alone canrelieve, then assist if you please, providedYou can assist with safety ; but, remember,that iever alone will not justify your inter-ference.If fever concur with parturition: in the

general, I believe, the labour will proceedwell enough, though it may frequentlylinger, the pains not being so frequent andpowerful. If floodings supervene, or otherdangerous symptoms, you may then assistartificially, helping with your instruments,the lever, forceps, or perforator, or turningthe fœtus, according to the circumstancesof the case ; but if, on the other hand,the labour lingers, and no symptom ofdanger concur, then, agreeably to the doc-trine already laid down, you had better trustto the natural efforts, of which you arenever hastily to despair. If the fever be in-fectious, and it becomes necessary to turn the

! child, some precaution becomes necessary.A friend of mine being engaged in turninga child, in a case where the mother labouredunder fever of -the typhoid kind ; he to all

appearance caught the disease from his pa-tient, and it had very nearly cost him hislife. If a woman is labouring under themeasles, for instance, or the scarlet fever,and you have not been secured by a previousattack, it becomes necessary that you be

upon your guard; I think yon would be

doing but justice to yourselves and yourfriends, were you to send for a practitionerwho has had those affections already, be-

cause, if it can be avoided, valuable livesought not to be exposed : if, however, itbecome your duty to act, of COIHse you must,at all risks, never retreating from your postfall we all must sooner or later, nor can wefall better than in the ranks. In cases ofthis kind, however, it may be proper tohave the patient lifted on to another bed;or, if this cannot be done, in order to keepdown the steaming vapour, it may not beamiss to raise the patient a little, and tospread out two or three blankets beneathher, before you begin your operations. Theprognosis, in these cases, is not favourable.

Extra- Uteritie Pregnancy.In general, when women conceive, the

ovum takes place, as it ought to do, in theuterine cavity, but sometimes it lodges inthe peritoneal sac, and far more frequentlyin the fallopian tube, or the ovary ; and thisit is that constitutes the extra-uterine gesta-tion, divided into three varieties, the tubal,the ovarium, and the ventral, according to

the situation of the ovum. To these threevarieties may be added a fourth first shownme by Dr. Ramsbotham, the younger, theutero-tubular, as it may be called, in whichthe foptus lodges in the uterine portion ofthe tube.

I have myself seen a fcetus, on the wholenot imperfectly formed, about the size ofsix or seven months, and which was takenfrom the body of a boy where it lay in asack, in communication with the child’s

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duodenum, the boy being pregnant. It some cases the tunica decidua is found tobeing, therefore, not impossible for a foetus form in its cavity, much in the samevayM uto form within the body of a rale, in such a if the fcetus were there ; this, however, li h]situation too, I cannot accede to the opinion no means constant. lllr. Langstaff, who hasadvanced by some, namely, that it is impos- paid so much attention to morbid ana:omy,sible that a foetus should form in women examined a case in which there was no well-,within the peritoneal sac among the abdomi- formed tunica decidua, and I have mY5e:rnal viscers. The probability is, that this seen two tubal cases, in which the deciduaaccident is possible, but that it is of very rare was wanting; while, in a third case whichoccurrence ; and I think with Dr. Merri- I saw, where the patient died between theman, that it is not impossible that some of second and third month, the tunica deciduathose cases that have been looked upon as being very distinctly produced in the uterus.ventral pregnancy, have, in reality, been When extra-uterine pregnancy occurs,cases of rupture, the case having been mis- whether of the ovarian, tubular, or perhapstaken for ventral pregnancy, in consequence of the ventral kind, the symptoms by whichof the discovery of the ovum after death it is marked are not always very inteHtgiHeamong the abdominal viscera, the rent in in the earlier months, whence it is not im-the womb being overlooked. probable, should you meet with a case ofThe ventral pregnancy being rare, of its this kind, that you may not recognise it till

symptoms I personally know nothing ; but after the’ decease of the patient. In theit is said that, in those cases, the placenta early months of extra-uterine gestation, theand fcetus form, in the ordinary way, the woman believes herself to be pregnant, forblood-vessels of the maternal viscera, en- she observes all the ordinary signs; but inlarging wherever the placenta chances to ventral pregnancy, according to Burns, thereadhere. Again :- is more irritation than usual in the alimen.When patients die, the victims of ovarian tary tube. In ovarian pregnancy, too, andpregnancy, a disease which is far more com- more certainly in the tubal, in connexionmon, we sometimes find a great deal of blood with this pregnancy in the earlier months,effused among the viscera, with a fœtus, there is a great deal of anomalous tender-perhaps, not bigger than the thumb, and an ness and pain and spasm, which is referred to

ovary laid open by laceration. More gene- one or other side of the abdomen, its lowerrally, however, in these cases, the ovary be- part more especially ; and after these symp-comes as large as the uterus, at the seventh, toms have continued for some time, sud-eighth, or ninth month of pregnancy, when denly perhaps, the patient is seized with ait is found to contain a full-sized fostus, with fit of collapse, under which she sinks, anda placenta often remarkable for its tenuity, this, perhaps, not always in consequenceor (as observed hereafter) this fœtus be- of abdominal haemorrhagy.comes putrid, and is contained in a sort of Gestation advancing to the latter months,abscess, where its softer parts gradually as in the ovarian pregnancy more especially,disappear, or, in the course of years, it is the case may still remain obscure ; the pa.transmuted into fat or bone. tient believes herself to be pregnant, butWhen tubular pregnancy has been the perhaps she exceeds the ordinary term of

cause of death, it rarely happens that the gestation, proceeding, perhaps, for ten,

fallopian tube becomes as large as in the twelve, or fourteen months, before any veryovarian pregnancy. I have never seen any conspicuous changes occur. After the filcase of tubular pregnancy, in which the term of gestation is passed away, however,tube was of great size ; more generally this it may be she is seized, sometimes earliercanal enlarges to about the size of a small and sometimes later, with pains very like

fist, sometimes to the size of a pullet’s egg the pains of parturition, so that she fanciesonly, and, in the early part of gestation, say herself in labour; under these pains, In

in the second or third month, this cyst burst- some cases very slight, and in others cerving open, the child escapes into the perito- severe, there comes away a little blood, andneal sac, and the woman suddenly perishes if the tunica decidua is formed, it is expelledby an internal hæmorrhagy. Many women, also, but of course no part of the fetus, thisI have little doubt, die in this way, but not being contained within the uterine ca-being buried without examination, the real vity. If, then, the practitioner examinescause of their death is never ascertained. carefully at this time, he finds that the t,-Three or four tubal gestations of this kind nica decidua is expelled alone, and, hsc!!’have taken place within the circle of my ing a finger or two into the uterus, easilyown obstetric acquaintance, whence I infer, searched in this manner, he finds it enlargedthat the case is by no means rare. and opened a little, but without the vestige

In extra-uterine pregnancy, the state of of a child there. These abortive attemptsthe womb varies somewhat, butitis remark- at parturition usually, I believe, reaie inable that it generally becomes two or three a few weeks ; but in some cases, and in c:,times as large as in its virgin condition, In of analogous kind which I myself sow, t:.:

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patient may suffer in this way for years. come to be a consideration, whether a sortThe woman to whom I allude, a native of of Caesarian operation ought to be per-Aberdeen, was anxious to have a sort of formed, or, at least, whether an openingCxsarian operation performed, that she should be made into the abdomen to take

might either get rid of her pains or her out the child. On the whole, however, con-life, and she came to London for that pur- sidering the danger of the incisions and thepose, the surgeons of Aberdeen (as she risk of a fatal bleeding internally, when;thesaid) having refused, and very properly re- extra-uterine placenta is taken away, abdo-fused, to perform the operation under the minal incision seems to promise but verycircumstances in which she was placed. little success, and, therefore, I should beHer sufferings had been protracted, and averse to try it. If the foetus, piece bydreadful indeed, so much so, that she had piece, is coming away from the abdomen,taken a razor, and had attempted to perform the best office which you can render the pa-the operation herself, and she showed me tient is, nothing forbidding, to enlarge thethe sear. opening, and to take out any parts you canAgain : before the parturient efforts occur, without violence. Sometimes the discharge

or after these symptoms are gradually worn of the fcetus occupies many months, or someaway, the patient is liable to be attacked years, and during all that time the patientwith an inflammation in the cyst, where the is kept in a state of cachexia, though, inftetas is; this giving rise to tenderness, some cases, I believe, she is relieved in apains, and stabbings, to adhesions, suppura- few months. Now if, by dilating prudentlytions, and absorptions ; and under these ope- if the orifice of the cyst, and removing therations the cyst opens on the abdominal bones with forceps, or otherwise, you cansurface, or less desirably into the vagina or accelerate the evacuation and shorten thisrectum, and, morsel by morsel, the foetus period, you may render the patient a verymay be expelled. In other cases, instead of effectual service.

terminating in this manner, the extra-ute- After what I have observed respectingrine pregnancy is brought to its close in a the history and treatment of this disease, itway very different ; nor is this the least in- is not necessary that I should say much

teresting. In this termination of the dis- apart respecting the characteristics of it,ease the ovum lies inert within the abdo- for these have been involved, in good mea-men for ten, twenty, and thirty years, or sure, in the statement I have already made.longer ; and during this time, as observed In the earlier months of extra-uterine preg-before, it becomes gradually changed into nancy, say in the first, second, third, fourth,a bony, or sebaceous, substance, occasioning or fifth, I have observed already that thethe patient little further inconvenience than characters are so obscure, that it may notthat which arises from its bulk and weight. be very easily recognised ; but if the woman,In this state of the genitals another impreg- after all the signs of pregnancy, be seizednation may, I believe, occur, with severe, but anomalous pains and spasms

I have considered these extra-uterine of the abdomen, together with fits of faint-enies in a mere cursory manner, as, in the ing and collapse, you may always suspect apresent state of our knowledge, they are tubal pregnancy more especially; and suddenrather matters of curiosity than the subjects death, in the earlier months, is in a high de-of much active treatment. If, in the earlier gtee probable. When tle full pains of par-months, the woman have spasmodic or in- turition come on about the ninth or tenth

fiammatory pains, you must treat them on month, then there is a fair cause for suspect-general principles. I have nothing pecu- ing that the pregnancy is extra-uterine. Theliar to recommend for them ; they are, how- woman, up to this moment, has believed her-e.er, both severe and dangerous. If you self to be pregnant in the ordinary way, andsuspect an extra-uterine pregnancy, you now she supposes herself to be in labour: if

Doght to mention to the friends the chance you at once examine the abdomen, you findof sudden death from internal bleedings ; it much of the usual form, its enlargement,and should that occur, this previous intima- however, tending laterally; but if you emptytioato the friends may, with reason, tend the bladder, and make a careful examinationto preserve their confidence in your skill through the abdominal coverings, you may,Mdhr.owiedge. If in the end of gestation at least, sometimes, distinctly feel the fun-a :reat deal of parturient effort occur, and dus of the uterus, just above the symphysisthe wound be found to contain nothing but pubis, large as after recent delivery ; and ifthe tunica decidua, and the abdomen is as you can do this, why then there is a goodlarge as in a pregnancy of nine months, and proof that the foetus is not there : moreover,the woman have exhibited previously all the if you can slide one or two fingers alongindications of pregnancy, there can be little, the neck of the womb, after the deciduat!My, doubt respecting the nature of the comes away, and it’ you thus insert yourcase, ard anodynes and opium ought to be fingers into the uterus, you may thus clearlyadministered. In such cases, too, it might ascertain the absence of the fœtus ; so that,

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by examining the uterus after the expulsionof the tunica decidua, by feeling the fundusof the uterus above the symphysis pubis, andby finding that the woman has all the painsof delivery, you obtain pretty decisive cha-racteristics that the pregnancy is extra-ute-rine. Of course, if inflammation and sup-puration form, and you have a discharge ofthe fcetus piece by piece, there can be nodoubt of the case. The only difficulty ofdetecting it will be while the inflammationis going on, and before the discharge of thefoetus ; a difficulty of less importance, be-cause, while the inflammation is proceeding,it must be treated on general medical prin-ciples.

I shall now close my observations byshowing you some preparations. Here is atubal pregnancy : from the size of the childit would appear to have been about threemonths old: of the age I judge from observ-ing its bulk. You will perceive, in thisextra-uterine pregnancy, that there hasbeen an enlargement of the uterus, and themouth is so capacious, that you may readilyinsert two or three fingers into its body.There is no tunica decidua here.Here is another preparation, very lately

enclosed in the glass. You see, as before,that the foetus is about the size of threemonths ; it rarely exceeds this size in thetubal pregnancy. The woman died frominternal bleeding; an ordinary terminationof this case. The uterus is enlarged, andthe fcetus lies below the fallopian tube.

If the woman survive, the fcetus maycome away after months or years, piece bypiece ; and here are bones which were dis-charged from the rectum-the tibia, fibula,and’bones of the cranium, and soon. I shouldthink, from observing the size of the parie-tal bones here, that the child must havebeen of 7 or 8 months old, and that it wasan ovarian pregnancy.

I here, also, show you some plates, forwhich we are indebted to Bœhmer, illus-

trating the escape of the ovum, when thepregnancy is extra-uterine.

Dr. Blundell showed the plates.

LECTURES ON ANIMAL

CHEMISTRY,BY

PROFESSOR BRANDE.

Delivered at the Royal Institution of GreatBritain.

LECTURE LII.

GENTLEMEN,—We may now go on to the

examitiation of some otlier proximate prin-

ciples of animals, and there is one very m.portant proximate principle to which wehave not yet adverted, namely, gelatin, 0rjelly, which exists in various forms, and isderived from various sources; but I maystate, that the true skin of animals is com-

posed chiefly of this substance. Accord-ingly, if you take a portion of the skin of ananimal and boil it, you will find that it fur.nishes, upon evaporation, a quantity of mat.ter, which, as it cools, assumes a tremulousform, which is known under the name ofjelly. You may obtain it from a number ofother substances, as from isinglass, which isthe air-bladder, and membranes of a speciesof sturgeon imported into this countrv, al-most exclusively from Russia; you find itin a variety of animal structures, but chieflyin the true skin. I have stated, that it con.cretes into a tremulous mass, but it differsfrom albumen, in being readily dissolvedin water, and you may coagulate it and

liquefy it any number of times, differing inthat respect also from albumen. It is easuysoluble in acids and alkalies, but does notform soaps with an alkali, as is the casewith albumen. It is prone to decomposi.tion in its liquid state, but when dried, as

in isinglass and glue, it is, comparativelyspeaking, a very permanent substance; itis supposed to be very nutritive, but of thatI have some doubt, at least I do not thinkthat it comes any thing near to albumen innutritive power; but it is found to agreewith the system when other kinds of animalfood will not.

Another character of jelly is, that it is

precipitable by the astringent principle ofvegetable infusions, with which it forms anindestructible compound. Here is a mix-ture of jelly and water, which would soonbe decomposed ; but if I add an infusion ofgalls, a precipitate is thrown down thereis a combination of the astringent mat.ter of the galls with the jelly, and vou

have here the principle of the art of tall-ning developed ; because in the skins ofanimals you have jelly in an organizedstate, which, when soaked in astringentvegetable infusions, the tan and jelly gra-dually combine, and you have leathff pro.duced, which is a very insoluble compound,applicable to a great variety of useful pur-poses, In the operation of taniiinz, it isnecessary that the jelly should be combinedwith the astringent vegetable matter verygradually. The tanner steeps the sLin atfirst in a weak infusion of bark, until it has

acquired a nutmeg brown colour, and thenhe gradually increases the strength of tiesteeping liquors, and after a time he Llrowsthe skin out, and finds that it is convertedinto leather. A thick piece of hide requiresten, twelve, or fourteen months, to be cas-veited into good leather, and when you


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