EXTRAORDINARY CASE OF DIFFICULT LABOR.

BY M. A. MILLER, M. D., of New York.

On a Thursday in last August, in the afternoon, I was requested to visit a Mrs. M. J. K. I was informed that she had been taken with labor on the preceding Monday evening; that the liquor amnii had passed off with the first irregular pains; and as the head of the child did not advance, it was deemed best to call in the family physician (see note).

I found that the presentation was right, but the pains were not sufficiently strong to expel the child, and it was apprehended "that there was want of space, owing to a defect of form." Means had been applied to excite the throes of the uterus and it was hoped that they still might, if rendered sufficiently active, accomplish the delivery. The pains had ceased altogether and she had a convulsive fit, some short time before I saw her, yet she retained all of her mental faculties and great strength of body, to an astonishing degree. I expected to have found her in a stupor, with more or less of mental derangement after the fit.

The physician in attendance informed me of the means he had employed and that they all proved unavailing. On examining her situation, I discovered the os tincæ fully dilated with the head of the child down in the basin of the pelvis, and was convinced that the labor was not impeded by any malformation of its structure.

It appeared evident to me, that from the shock the vital powers had received from the convulsion, it was necessary in order to save her life, that the delivery should be effected at once. I recommended the use of forceps, and was told that they had been used some four or five times before I arrived. In the meantime, as her pulse was much depressed and she had began to show prostration, it was thought proper, with a view to prevent the recurrence of the convulsion, to rouse her by administering some nervine stimulants. Repeated attempts were made with the forceps to extract the foetus, but all was useless. The head would seemingly yield a little, but by the continued application of force, the cranium would give way and slip from the blades.

On examination afterward it was discovered that the head occupied the same place as before. I became satisfied that the delivery was impracticable with forceps. I introduced my hand, to turn the child and deliver by the feet. But, to my utter astonishment and fear, I reached a part so tightly inclosed with the uterus that, with the utmost exertion of the hand, I passed my fingers between it and the body of the child. It seemed to me that when the head seemingly

yielded to the forceps it was the uterus with its contents that was drawn down toward the pelvis, and, what surprised me after all these attempts, the contraction now extended itself in an increased degree to the os tincæ. My fingers became numb; I could scarcely move them for some hours after withdrawing my hand. From manual examination and combined circumstances I inferred that it was a case of what is usually called "the hour-glass contraction," met with often in the retention of the placenta, but never apprehended by me as a canse of failure in delivery.

From the prostration and exhaustion of the system, I considered the case beyond the reach of human means of relief. It was then suggested to call in Dr. W., who responded with promptness to the call. Chloroform was given to relax the system, and the forceps again used, but with the like failure of former efforts. After some sixty-five hours of terrible agony to the patient she passed away.

Mrs. K. was twenty-six years of age, of low stature, small-boned, extremely fat, and in a healthful condition. This was her first pregnancy, and her health was unimpaired during gestation.*

Mrs. K. had a good appetite; seemed very fond of cheese, often eating from a quarter to a half pound at a time. Her bowels became constipated, and, from the advice of some friend, she took a cathartic, and was threatened with an abortion. I was sent for, but, being confined to my bed from an hæmorrhage, and thinking that it was only a fancied sickness on her part, I said she might come to me, which she did in a short time. On examination I found really cause to fear that she would abort. I questioned her closely about her habits, and to know if she had done aught to bring on this condition, and then learned of her having taken some powerful drastic, ignorant of its action, and almost demented at the thought of losing the fruit of her womb.

I succeeded in saving her from its loss, and, while treating her, I seemed to feel that it would be better for her did she lose it. I told her, then, that as she was married, and away from the care of her father, I would rather her husband should get another physician for her. She told her mother that I had refused to attend her. The mother called on me to know my reasons for it. I explained them, and the mother was satisfied, and pleased her by telling her that I would go to her daughter as a friend and neighbor if her daughter wished for me, and if the physician consented.

Did I know any thing of clairvoyance I should say that I foresaw what she went through and suffered. I gave such a demonstration of her future condition, so plain a picture of her case, to her mother and a cousin, that they have asked me several times since how I could know this.

I was sent for, as a friend, as she had constantly asked for me all

* I had been the family physician in her father's house for some four years before her marriage, which was just ten months the day she died, I was informed by the young wife and her other that she was pregnant, and the "coming event looked forward to with the greatest of pleasure. "As I had been to the wedding, so I was to receive the first born."

was

of the day. The two physicians who were in attendance asking also that I be sent for, and they would willingly have thrown all responsibility of the case on my womanly hands and character, and, by so doing, screen their own ignorance, or throw the reproaches of her family on me.

I do not hesitate to say that I truly believe that the woman might have been saved, at the sacrifice of the child, some forty-five or fifty hours before. Yet I know these physicians worked hard and did all for her that they knew how. I induced the husband and other relatives to allow one of the attending physicians and myself an examination of the body. This gentleman and myself opened the body some two hours after her decease, and examined the state of the uterus, and found the deductions I had made, from manual attempts, entirely confirmed. The uterus was elongated, forming a tight case over the breech of the child, which felt hard to the touch through the external integuments. On opening these some excessively noisome effluvia escaped, evidently produced by incipient putrefaction. It was closely contracted on the body of the child, presenting inequalities corresponding to its shape.

It occupied the left side of the cavity of the abdomen, pressing the intestines to the right side. Near the neck and shoulders of the child the uterus had the appearance as if a circular band, about an inch wide, had been tightly drawn around it. The stricture had a prominence on each side, forming, as it were, a groove in its course around that part of the uterus. It was this which I felt in my endeavors to pass my hand over the back and shoulders of the child. This fixed contraction, as with a cord, bound fast the foetus, and presented an insurmountable barrier, defying all the efforts that were used at delivery.

The foetus lay in its natural position, with its breech uppermost, the knees bent and feet drawn close to it. It was a male child, weighing twelve pounds, and perfect in form. From the elongated state of the uterus and the close contraction of its parietes on the body of the child, it would appear as if, in the parturient organism, the longitudinal fibers acted feebly, perhaps impeded by the resistance occasioned by the stricture, if it existed antecedent to their action, or, perhaps, overcome by the more powerful contraction of the circular fibers. In this way the energies of the uterus must have been exhausted in fruitless efforts, and the consequences which followed were inevitable. In reviewing this case we may be led to consider, in reference to practical inference, whether this irregular contraction of the circular fibers of the uterus might not have been caused in some measure by a peculiarity of its organic conformation, and what would be the effect of a copius abstraction of blood (old times) and the administration of ergot, in the early stages of labor attended with such circumstances.

I have never read, heard or met with a similar case, nor did it ever occur to my apprehension that an irregular contraction of the uterus, of such a character, might frustrate its functions in the expulsion of the foetus.

DISEASES OF THE EYE.

Read before the Eclectic Medical Society of the city of New York,
By ROBERT S. NEWTON, JR., M. D.

My attention has been repeatedly attracted to the circumstance of the scarcity of reliable data concerning the treatment of diseases of the eye, in the eclectic school. We can peruse all our leading journals scarcely ever seeing a case reported, or if one has chanced to slip in, upon reading the report through, we will usually find appended the name of the periodical from which it was selected. I have often been asked by hospital associates, if we ever treat any ophthalmic cases. It is to be deeply regretted that so little attention is paid to so important a subject. With the extensive materia medica, this purely distinctive feature of our school, we could compete with, if not excel, the present system of ophthalmic practice. That our school is doing itself an injustice in not progressing with the times, and especially with our contemporary schools, is apparent to all. We come to take the lead, and if the old practitioners and pioneers of the school will not represent us, then the younger men must take their places, labor in the field of advancement until we can be as proud of our work as our rivals are of theirs. It is an error that the younger men of the school should be so reticent in the presence of these older practitioners, who are apt to relapse from their advancement and truly wonderful progress in the past, and allow the present to glide away without making that same effort that was so characteristic of their work twenty years ago; in truth, their work is accomplished. I do not mean to imply that they are ready for interment, far from it; but that it is time for the younger men to step forward and take part in the work which, before many years have rolled away, will devolve upon them entirely. I have thus earnestly presented the subject before the society, in hopes that our meetings in the future will not be devoid of interest by there being no essays or reports of cases; if each member does his duty to himself, we would hold daily instead of monthly gatherings.

I propose in this and subsequent papers to present the most frequently met with diseases of the eye, with special reference to their eclectic treatment. My paper this evening will be upon "Tra choma and Pannus, their eclectic treatment." Trachoma or granular lid is a condition that is familiar to all. I only refer to it as a cause of pannus, which is one of the most intractable and discouraging diseases (that is under the present plan of treatment) that we meet with in ophthalmic practice. The so-called granulations are the

papillæ and follicles of the conjunctiva, enlarged by inflammatory deposits; by their prominence they cause squinting and blinking of the lids, which produces constant pressure upon and irritation of the cornea, giving rise to the vascularity known as pannus. Without entering into details I will briefly review the plan of treatment followed at the New York and Continental hospitals. To attempt to cut the entire crop of granulations away at once, would be liable to produce permanent curving of the tarsus, producing ectropion.

Within the last two years I have seen six cases where the same condition, namely, eversion of the lid, was produced by the use of nitrate of silver. The ordinary astringents, as alum, lead and tannin, are inert. In fact, under this plan of treatment, Trachoma is chronic.

I suggest the use of the Susqui Carbonate of Potassa, applied in substance every other day, or as fast as new crops of granulations show themselves. This appears to act by chemically saponifying and dissolving away the hypertrophied tissue; this is to be followed by the use of the warm ulmus poultice. There is nothing to apprehend in the inflammation produced by the Potassium. If there is much agglutination of the lids, apply mild zine ointment. If much pain is complained of, or there is considerable swelling, the eye can be kept bathed with:

Hydras. Can., grs. xx.
Sulph. Zinci,

grs.

V.

Tr. Gelsem.,

3 i.

Pannus is characterized by a superficial vascular opacity of the cornea, occupying more or less of its extent; the opacity usually commences at the periphery of the cornea, and encroaches upon the center. The vascularity of pannus differs from most hyperamic conditions in that the vessels come from the conjunctiva as branches or twigs; upon reaching the cornea they pass over its margin, ramify and anastomose on the surface until they form a complete net-work of vascularity with transparent spaces of cornea between their larger branches, sufficient for vision. As the vessels increase in size and number by encroaching upon these spaces, they become opaque, producing total loss of vision when the fundus is perfectly healthy. In the acute form of pannus there is considerable lachrymation and ciliary neuralgia in the intense conjunctival injection. If the disease is very protracted, the eye loses its sensibility, except when exacerbations occur. The surface of the cornea becomes gradually more opaque, rough and irregular, its epithelial layer becomes thickened, so that it resembles the cuticle; this roughness is produced by loss of