BMJ

Report on the Practice of MidwiferyAuthor(s): John LeeSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 8, No. 27 (Oct. 2, 1844), pp.414-415Published by: BMJStable URL: http://www.jstor.org/stable/25498122 .

Accessed: 15/06/2014 12:51

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact support@jstor.org.

.

BMJ is collaborating with JSTOR to digitize, preserve and extend access to Provincial Medical and SurgicalJournal (1844-1852).

http://www.jstor.org

This content downloaded from 188.72.126.35 on Sun, 15 Jun 2014 12:51:34 PMAll use subject to JSTOR Terms and Conditions

414 REPORT ON THE PRACTICE OF MIDWIFERY.

tozthe importance of this longtendon to the joint. He

considers that the long head of the biceps is not designed to actmerelyasa ligament, but also to act as a capsular.

muscle, antagonisig the action of the other capsular

muscles, by preventing the head of the hone being drawn upwards and forwards.

, The tereamajor, arising from the inferior angle of the scapula, ascends forwards and outwards to the

innerlip of the bicipital groove, into which it is in

serted behind the tendon of the latissimus dorsi. In

its course it is separated from the teres minor by the

long head of the triceps. These are the muscles usually described as the mus

cles of the shoulder joint. I think this arrangement by no means complete, since it does not embrace the

whole of those which act either directly or indirectly

upon the articulatin. The levator anguli scapulae,

trapezius, long, head of the triceps, latissimus dorsi,

pectowi major, &c., must all influence it, more or

less, as you will fnd when we come to the consider

tion of .the motions of the joint and the mechanism

by which those movements are effected.

,The arteries supplying the shoulder joint and its immediate muscles, are derived from the supra-scapu lr, trasversals colli, subscapular, and circumflex.

,The veins follow the direction of the arteries. The absorbents are arranged in two layers, superficial and

4eep. The superficial layer passes to the glands in the x ila; Mle deep into the deep glands of the neck.

wThe nerves are very numerous. They are the termina

tion" of the spinal; the supra-scapular and circumflex.

REORT ON THE PRACTICE OF MIDWIFERY. . - } Jo}N La , M.D.

TO THn DrrITOR OF THE PRDVINCIAL MEDICAL AND

SUjGICAL JOURNAL.

SIa, HavinS read Dr. Toogood's paper "On the practice

of pidwifery," with much interest, I foFward you the

resui'ofh eig ht iundred and fifty cases, that have

occurred in my own practice during the' last tfew "CUM . g [ . ! . ; . . I: .0 !. C

' thiis nuim ibr one hundred' and seventy were cases

of'fIlaour.

rn Jityiine cases the fuhis encircled the neck 'f ti/ cfuid: ''1ai seven cases the funis was twice round the anck; anid in three cases It was thrice round; in all of which it was necessary to divide the funis before

tisihoild'ts cduld be born, and in these ten instances

the'i;bouri s er'every lingering and perplexing. In te 'easss the'fiis' was round the arm as well as the

nefk; aah d in three it was robuhdthe thigh as well as the neck.

In five cases hemorrhage occurred before partu rition; in three it was stopped by rupturing the mem brh s;'' and in One it did' not cease till the head was

pr'iig Ot the perinetum; and I have no doubt that in t[seitasesi a portion of the placenta had been detached

from tree it.rus, b ;oer exertion on the part of the iiShidual; in; bn case the patient was delivered with the forceps, b^ ifbak ixAusted by the loss of blood, alout half an hiu.r after. " ' ' .

iSe'ti'r"' 'Ats/tn iwas' hemorrhage after delivery; thee f i'f'vhih' ie'e atinded with hour-glass con triation r the i iters, an n thems tie ehmoirriae

Cwduit t reo*al of the placenta. I evge

the secale cornutumin-cases-of -hmorr _- Ain

after the birth of the child; trusting to .wme xeptp

nally, and the introducton oi the han4, wheme* uterus is distended by coagul, (as in fol th aow e seven cases) or, where the paceubta rui s tP w taken away.

.

Two were cases of funis presentation, in one of

which the liquor amnii had been discharged some time

before my arrival, and the pains had nearly ceased.

The midwife told me "all was not right, for the navel

string was born." Upo proceeding to examine (4is covered a portion of the fuais lying without t.he qo externum, and, pursuing my examination, could disA

tinctly feel the umbilics and abdominal prieetes of

the child. Introducing my hand . got .ho l oL e o foot, and brought it down, the other following soon after. The child was in a state of aspb~yx,.but by

warmth and inflation revived. The woman was n not her full period, and attributed the poitiqn of the chd

to her having fallen down stairs about, a.fortnight p re

vious, from which-time, till her delivery, she b4A, neve felt well. In the other case the funah Ial doAwn before the head, and the woman being in a vry.wl. state from previous illness, and having a ready in

the hands of a midwife for some time, the dliveryiof the child was effected with the forceps. ; .,

In five cases the breech presented, and three out of

the five children were born alive. My practice in these

cases is always to allow the uterine efforts to expel the

breech, never to bring down the feet with .a view to

expedite delivery. . Nine were cases of twin births, with the following

presentations, viz., ten of the head, eight of the fefee one of the arm, which required turning. Ten.eof the

children were males, eight females .AIn ive ames there was oneof each sex; in two, both children wre mad and in two both females. In two bf the twnacsm

the placenta of the first child *as detachedad expelled before the birth of the second.. In one insane the

child had been born some-time before my arrival, ; and

upon making an examination,- I found the dacenta

lying in'the vagina, wich was in a very few hinnutd

excelled by the uterine efforts. rhere 'bbing *

unusual hinorrh age, in fact, less .disceage.'tin o: former occasions, I neglected to' follow ny.otherw invariable rule, viz., to place my hand on the abidome,

immediately after a child is born, to ascertain whether or not there is a second.

* In about 'an: Bor rygu!hr

and strong pains came on, which,-increasing, induced me to institute a closer examination, which discosed the presence of another foetus in utero; this :as soon expelled, enveloped in its proper membrane, (the liquor amnii not discharged,) and accompanied 'by its

placenta. In the other instance, on proceeding tow examine the position, and presenting part of the second

child, I found the placenta lying in the vaginga id could distinctly feel the insertion-bf the fnnio' in- tist case there was more discharge than in the precedrg, but not sufficient to induce any feeling of faintuess, and the second child followed in a very few paitg after: wards. All the placenta were healthy, and. pressed no appearances of ever having been united, . -

Thirteen were cases of presentation of thelower extremities-the cases of this iresatiot ecerrinlg amongst the twins, -re notinludedi*i tli.nnuhdte . ,,

': FiW e s presentr*ifth he f 6tdihbje ^ibi "ad

This content downloaded from 188.72.126.35 on Sun, 15 Jun 2014 12:51:34 PMAll use subject to JSTOR Terms and Conditions

HYDROPATHY. 415 I ~~~~~~~~~~~~r - C~~~~~~~~~~~~~~.II 1 .....I.- I I-_

in all these the labour was very protracted and lin

o trl er- ci es of preseratio of the placenta. In the ,ftiuesb orsuinrastttheb 1 ill term of uterine ge&I ^t-p ti cbie4, w*MfrtUtdd qnd delivered, but stiU b o; ,t5e. WPpand a -uf k, iecov.ey. In the second

a t.he;9 ,Wa jhpr br eighth month of preg, nancy: she had e:pprienced a sliht "shew" a week

before, but it^Vidisoo'niesed. In consequence of her carrjnin;o; obfhee hiiitren, a violent discharge of

tdDo<e& 1ail , h W Im ha4 leased before ;my arrival. Sib- w4a? dai io bIekept qulet in bed, and to have

cob;ivboid-dritaks. : On thle following day the hemorrhage returned with increased violence, attended

wiltbslijt tprineppains. The, os uteriy was found to

be sightly. dilated, with the placenta attached.directly over it. 'Peeling persuaded that'slhe would nbt survive

itothb[ si&/;'"* : rifn upon. her; frame, II "proceeded

sdo*Iy iti cautiously to deliver her, by turning :the

child an snvporting the mother during the time with

wine ,nd cordials. ' The, child was atiU-born, but. the,

moa er had,,n! niunterrupted .good recovery, In the other cas ,dePvey. wa. also effected by turning, and

the patients,did well.

Fiv.cases, occurred.of adhesion of the placenta,

requirg ,tse introdutti6n of the haltd for its removal.

'nt the e s arm, presented; in two of them

thie piarif bteein 'iome hoius under the care of a

imd*ife,.ihb' ead in 'the first isstaace been "carefully"

putling thd:prttitng 'prt, under the full conviction thati-tiWa^at fotr, L had, therefore, in both cases to,

t~nfi.a^or.ite4 uterus, an operation under such circuamst poe oftenexetregnely fficult, and only to be.

efted by pa.atieqt.perseverance.

,Purp.erj oo1nvulsopqs occurred in two cases, the first 'proed fatel, the second recovered. In both

thi ~'nvilSiotnsr caime o'f during"' the excitmeat

ofdpiarttuiitonr 'Tnidderig o6re-filness of tht' vessels Mki1^ f6tW d#Wth Y&lattst *6qWe0it pfit atel^ cuse of

thirimta m' tlsieditdy dbstrated ;blood, in

quantity proportionedte t :,e natitition of my paOi,., oqe bigg fi full.habit, tbq pther the inmate of.T :wprh ... nThe convulsions, happned when the

'head wa? low aow in the pelvis, and just pkesstpg on

tti Eitniuf"i'; 'the os uterf''fully dilaed;' 'A.fter' ife

btedi`g,'delivey was efficted witi'the forceps.' Where

ancoaevdi t ;Otir: diuig" the 'first'eight months of

pregnant , it is probable they are derived. from an

hyveiFocte e but "when: they take place during the

pB~ apt fpartit?ipp ,they evidently depend on an

over-Qoted.4tte pf ,t!e vesels of the head. In the

former case, local bleeding by means oof leeches, or

cuppligs, (vh^i latter is;' t% inA,-preferable,) may

dctda |irsoti n be bfAirient; liut'in the latter blood must

be^'biJaitId, ' a 'a ttht in: lrge: quantities, and-'if

aecssmat: repeated;' ? r all oases, however, applying cold evaporktingoashes to the head, aid tenewingxtheit

application according to the rapidity with which the

heat re-accumulates.

I lepti a'rejister of forty-three cases in which the

ergot oft rye was administered. In four no uterine

action was produced; but a burning-sensation was fell

at the pit of the stomach, which soon disappeared, and

ima in btStanei up'm"repefting 'the ergot,' the saine

seai' olatip dt ed.i It' filed als: in;ofe caZe 61

ieUiL E c^n'ati d the only one in which I tried

it. Ten of the cases were first labours. iha cire where the' patient,, nt ech of hi prcouh iW

(five in nuipber,) had suffre'd fr' cobiifi hemorrhage, the ergbt vas fsuccjsic . f '. being lan!uid, I gave her aboht two ciuples of 'tt e

powder in a cup of warm te ;^-this waifoiiol d intett minutes by strong proplling pinss; an' .-~tWhW s born in less than twenty minutes after -e';do4'a taken. No haemorrhage 'fbiibwt d, a'nd'hetr;'r.i;hr'

was unusually rapid. "t'he ergot Is ;coijtliJee t an injurious effect upon 'the" fetis. ' sits if""t f' found to be the case, inasmtuh as Wh3e A the eiht1H been given, and tbe child "till-bir, liEdei l4.aa evidently taken place some tipiei bfoiie.'

J ' ' rolHl , .,-'' Market Bosworth, Leicestershie,

' ,

Seiteimber 2 1844.

EFFECTS OF THIE WATER- IT&EMdWNTI

By WILLIAM JoLus, MI.f Lutte brt, ';

(Read at the Anniversary MpeeftirP.of ^..piw Medical and Surgia.l Aosoqitiop'A Ul%; t,, jA t , )

During the month of. December 1843; ;sa ands .ut

twelve days in Jtmary, 1B44vI ! intm ndaotie q

Lady B. As Iwvas tresid in thebo eimdlii' &c., with the family, I had an opportunity of .dil

seeing the/ e tffet of Sihat is miscalled the water-cure

on the Baronet. He one day inyitletn aedtl?a:in what is called the packing,, whichis being.enlnd in a wet sheet, then covered with blankets and feather beds for two hours, inrd-d iig violent persprltion. At theepd ofa tha ti#i _ t

,patiefs J immersed in a batfi, either cold or heated, to aboa 65? Fahrenheit. A. seUtii then /']irowo'd im, and

rubbing applied for :amite --or-two, outside the

sheett.

.As the patientewa 73 years of ,ae a4lhad bet my friend for, mnny; eas,j and wafa ar , r Squ and inflammatory habit, [,tol4,him my fearsas ts,.t

dangers he was running, bu.t he felt no. ill effects tifl After: tlie middle of eiecenber, when flnd^diit IIe f had rettirned, and Was l4inkabouIttiimb ^'wasTuidti to leave off -those violeav sweatings,. H 'hoet*iIt

for Sir Charles Scudamore,wvto advised himtd gptd as he said at Graefenburg the . contiei-: theap ft4q two or three years. OneR morpr8la.a~;synp ipq

erysipelas of the head. I apprised them ofhf h .d9g in my opinion, but it was disregarded, as

they p

tended to cure everything b water. ; On the: morning'o:f the - of January, on

'in" him immediately after coming out.of, the erooe Wii

he lihad been ,sweated and buahed,l IL saw tIbe tlob

4ountenanee quite purple. I thet iofar leghif'tAim" that another, such a si4ocjk w I ?pul byjrPWR ft death atonce. During tle day, I observed ,e hah pains in the limbs and a cough; the foflowingntrnig

I left London, and was sobrr'though not surpriIed,it a few days afterwards t hear ti his edeatn,: d'i

having recovered the shoeklbi n the Friaf, !*hlht4 mrinated fatally on ;the. followinMg Monday. sekb

hld- pro04ud,4 violent c ogh with btqop4Y,jptj a,4 the last few :day, lehargic i Beins ibt)[,a ,fL.w informed.

Some months previous to this case, i was co:suTte. by a lady advanced in years, who I saw -hd been . , , . . . - . . . :if

This content downloaded from 188.72.126.35 on Sun, 15 Jun 2014 12:51:34 PMAll use subject to JSTOR Terms and Conditions