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that she had probably conceived, and declined to prescribe any medicine for ber, as the indications were not distinct.
“ About the middle of the following March-five months afterward-in the intervening time not having heard from her, her husband, much pleased with the prospect of a family, told me that my conjectures in reference to his wife's case had proved correct, as she had quickened, and could then very perceptibly feel the fætal motions.
“From this time the pregnancy progressed with no unusual characters, until about the 1st of August ensuing, full nine months or a little more from the date when it was expected the conception occurred. The patient assured me that the morements of the child were strong up to this period, when they ceased, and were never afterward felt. There was a copious secretion of milk which continued sev. eral weeks.
“After this the health of the patient remained remarkably good, and she ato tended regularly to her domestic duties until about the 15th of February following—six months and a half from the date when the fætal movements were last felt, and from the time of her expected confinement-sixteen months from the supposed date of the impregnation—I was sent for to see her, as the long-expected labor bad begun. I felt greatly relieved upon an examination, when I ascertained that it was really a case of uterine pregnancy; for having never been permitted to use the vaginal touch unti! that time, I was fearful it might be extra-uterine. The labor-pains continued feeble and at long intervals for several days, producing but little effect. Five days after they began, the os uteri, although soft, was not dilated larger than a silver dollar. She was so much exhausted by the loss of sleep, &c., that I determined to deliver her artificially-had tried ergot, and its only effect was to put her to sleep.
“I decided to perform craniotomy, as the child was certainly dead. Upon rupturing the membranes, the usual quantity of liquor amnii was discharged, of rather a dark color, but entirely free of putrefactive odor.
“ The child was delivered without difficulty, with the crotchet, and measured twenty-two inches in length, but appeared emaciated. The placenta had rather a scorched appearance, and was much smaller than usual at full term. The child's skin was much darker than natural and rather tender. No fetid smell was perceptible during the delivery, nor was there any hemorrhage.
" The patient made as good recovery as is usual after first labors, and has since enjoyed tolerable bealth, but bas not concelved again.
" Whilst upon the subject of "blighted ova," I will give you a few points in the history of another case which occurred in my practice some twenty years ago.
“Mrs. H, a very delicate lady, was married when about forty-five years old. She became pregnant soon afterward, and her gestation proceeded without unusual symptoms until almost the sixth month, when she ceased to feel the more ments of the fætus and began to be troubled with nausea, which increased to such an extent that a teaspoonful of the blandest fluid was ejected almost immediately after being swallowed. This state of things continued about six weeks, notwith. standing the use of the best means of help which could apply. By this time she was very much emaciated something had to be done for her relief. As a last re
sort, immediate delivery, if possible, was decided upon. Her symptoms at this visit were so urgent that counsel seemed out of the question, there being no physician of experience within twenty-five miles of me.
“I proceeded at once to rupture the membranes, and tried artificial irritation and ergot to induce pains, but without effect. After waiting an hour or two, the 08 uteri being soft and dilatable, I determined to deliver without pains. Fortunately for me and the woman, as I then thought, the feet presented, both of which being easily secured, no difficulty was experienced in the delivery until it came to the head. At this juncture there was entire arrest, as the skin was so tender that any considerable traction was attended with tearing, and the lines of the under jaw so imperfectly ossified that no traction could be applied to it.
“Decapitation was then performed, and by the use of a pair of blunt scissors the scalp was removed. The bones of the cranium were extracted separately by a pair of straight tooth forceps, the only instrument at my command on that occasion except the scissors, which I found at the house.
“There was no hemorrhage. The fætus and placenta presented about the same appearances as in the first case which I gave you. There was not an expulsive pain from the beginning to the end of the delivery. The lady recovered rapidly without any unpleasant symptoms of any kind, but has had no subsequent conception.
“These cases occurred long ago; but they were of such extraordinary character as to so fix themselves in my mind that from my notes, taken at the time, I am able to give the above account of them, upon which you may rely in all particulars. Yours truly,
J. J. Warts." With the above cases, communicated by Dr. Watts, I desire to present another of my own, which has fallen under my observation since the publication of my former paper.
About the middle of last Jude Mr. L- consulted me in relation to his wife, informing me that she was about six and a half months "gone"—that the motions of the child had been more active than ever before, (fourth pregnancy), until a few days before, when, after a day's house-cleaning, they had suddenly ceased, and had not since been felt. At that time her breasts were tense and had some milk in them, and her health was uninterruptedly vigorous. He desired to know what conclusions these facts suggested, and whether they threatened danger to mother or child.
From that date until the 3d of August the same story was often repeated to me--the breasts now subsiding and regaining their virgin color and appearance-the abdomen no longer increased in size, but about stationary—the child hung like a dead weight in the uterus, and made no motion except a passive slide from side to side as she changed her position in bed-her health vigorous as it ever is.
On the morning of the 3d of August I was called to see Mrs. L
and found her in labor. By the touch I discovered the vertex presenting a few hours afterward, when the os was well dilated, I ruptured the membranes, which discharged about the usual quantity of fluid, with normal characters so far as I could determine. Soon afterward the whole fætal mass was expelled at a single effort, making the delivery complete. Each of her former labors was tedious—this occupied but about eight hours. On the former occasions she had suffered terribly from post partem hemorrhage, which was followed by excruciating after-pains. This time the only blood stains were from old dead blood-even the lochia was of such, and the expulsive effort which delivered the ovum was the last “misery” which she had.
The child by its growth showed that it had attained about six and a half months, the time assigned it. The flesh was firm as though it had been compressed, the skin dusky-brown and so tender that by a little force the cuticle would slip—the chord about the size of a crow's quill, the exterior showing no signs of vessels—the placenta small, compressed, and looked as though it had been about half dried and then smoked. The membranes were nearly natural in appearance.
The ovum presented no signs of putrefaction except the tenderness of the skin-it had no fætid odor-the only odor which gave any signs of petrefaction was from the dead blood discharged from the uterus before, at and after the delivery. Mrs. L- convalesced very satisfactorily.
It will be observed that the signs of the death of the child in this case occurred at the middle of the seventh month of gestation, and that it was born about the first of the ninth monthsix weeks after the death.
Let us now recapitulate the four cases reported-two by Dr. Watts and two by me:
Period of gestation at which death of the foetus occurred-one at nine months, retained six and a half monthsmone at six months, retained twelve months--one at six and a half months, retained six weeks and one at six months, retained six weeks.
In these cases the mothers suffered no inturruption of good health by the dead child—in the fourth forcible delivery was necessary to save the mother's life.
In three cases there was no stain of fresh blood at the birth. The report of the fourth does not mention the facts in this respect.
The convalescence of the mothers was unusually quick and easy in three cases, and in the fourth about as common.
The ovum was perfectly preserved from putrefaction in all except that in the two discharged at six weeks, the skin was more tender than in life. The general appearance was the same in all-the membrane entire--amniotic liquor pure and sufficient in quantity-the placenta and fætus condensed, presenting the appearance of having been dried and smoked-mummified. These changes the greater in those longest retained. Dr. Watts reports that both of his patients were afterwards sterile—my first one was 90the last is too recent to furnish any evidence in this respect.
Other interesting reflections relative to this interesting subject occur to me, but I can not express them now.
COMPOUND FRACTURE OF THE INFERIOR FOURTH AND
CONDYLES OF THE FEMUR, WITH DISLOCATION OF THE PATELLA UPON ITS EDGE, BETWEEN THE CON. DYLES.
BY A. J. IRWIN, M. D., FORT WAYNE, IND.
About sunset, on the 31st day of October, 1868, John Wycoff, Esq., aged forty years, while assisting at the raising of a grain-house, was struck by a falling timber.
The frame had been raised in sections, each of which consisted of three posts, and a plate-posts six by six inches and ten feet; plates six by eight inches and sixteen feet. The last section was forced up rapidly and fell inwardly, while Mr. W. was in the act of crossing a sill directly under one of its outer posts.
The stroke was received an inch below the great trochanter, and swept down the lateral posterior surface of the thigh, within three inches of its outer condyle, while the lateral anterior surface of its inner condyle was fixed upon the margin of the sill.
I visited the patient about three hours after the accident. Found him much depressed. Diagnosed the following rare form of fracture :
Four inches above the knee a double oblique fracture of the shaft, with division of the condyles into the articulation, and dislocation of the patella upon its edge between them, in which position the latter was so deeply impacted as to be quite obscured.
As motion produced insufferable pain, I adjusted the lint as comfortably as possible; prescribed opiates and cold-water dressings.
November 1–Anæsthetized the patient; proceeded to elevate the patella, which was difficult to accomplish, as anticipated. Having made extension to release the sections from the soft parts. was raised about twenty degrees above the plane of the thigh, thoroughly relaxing the quadriceps, in which position it was held by an assistant. The wedge-like extremity of the superior fragment was then pressed up between the condyles, the inner condyle depressed, and lateral motion made upon the patella, which completed its reduction.
The partially dislocated condyles were adjusted.
The limb was bandaged while well extended, and immediately placed upon a "double-inclined-plane splint," from the superior plane of which a crescent had been excised. This apparatus was made especially necessary by the necessity of local treatment to the contused lateral posterior surface of the thigh; short splints were applied to prevent separation of the condyles. A weight was suspended to the limb to assist in preserving extension.
Cold-water dressings and full doses of morphia prescribed.
November 2—Fever; parts much swollen. Prescribed Dover powder; leeches to knee; cold-water applications continued.
November 3—Fever abating; more leeches to knee. Treatment continued.
November 4-Less fever; slough forming over the contused surface six by twelve inches.
November 5—Free of fever; swelling abating. Prescribed carbolic acid in linseed oil, one drachm to eight ounces, to be applied to sloughing surface; sulphate of quinine) i.; aromatic sulphuric acid, zss.,, in Zviji brandy; a teaspoonful to be taken every hour. Restoratives being demanded, opium at night to procure rest and allay spasm of limb. This treatment was continued until November 10th, at which time the slough separated to the depth of the integument only, exposing partially occluded puncture, made by point of external condyle; general condition improved. Treatment continued, omitting brandy. Synovitis subsiding.
November 20—Slough entirely detached; denuded surface doing well; dressing prescribed in half the former strength. Other treatment suspended. Extension preserved with great difficulty—the pa