The accoucheur, a treatise on protracted natural labours; suspended animation in new born infants; and uterine haemorrhage after the birth of the child. With illustrative cases

Front matter

RADFORD LIBRARY,

Fine for overtime -__per day.

Note. — No book can be renewed if wanted by another reader, nor unless brought to the Library for that purpose.

Preface

though these defects may be found to run throughout the fob lowing observations, it is hoped they have at least to recommend them, their truth, honesty, and usefulness.

Being conscious that the absence of beauty of style is not inconsistent with the display of professional skill, when we contemplated the publication of this work, we felt persuaded that a confession of the want of the former would not deprive us of a claim to the possession of the latter 5 but farther reflection has convinced us, that when any innovation on longestablished practice, and deep-rooted prejudices is attempted, no apology the author can plead will, at times, secure the candour of the professional reader, and prevent the merits of the practitioner from being visited with the blame that is only due to the deficiencies of the writer. Jn self-defence we might therefore have felt ourselves justified in at present veiling our name in the method so widely practised by the literary world.

The following will show how little confidence can be placed in professional men, as well as others, even when the discovery is of paramount importance.

That learned and elegant writer, Dr Southwood Smith, in his useful work, entitled Philosophy of Health , chapter, “ Circulation of the Blood,” states, 44 Contemporaries are seldom grateful to discoverers. More than one instance is on record, in which a man has injured his fortune, and lost his happiness through the elucidation and establishment of a truth which has given him immortality. It may be that there are physical truths yet to be brought to light, to say nothing of new applications of old truths, which, if they could be announced and demonstrated to-day, would be the ruin of the discoverer. It is certain that there are moral truths to be discovered, expounded, and enforced, which, if any man had now penetration enough to see them, and courage enough to exvii

PREFACE,

press them, would cause him to be regarded by the present generation with horror and detestation. Perhaps, during those eight years of re-examination, the discoverer of the circulation sometimes endeavoured in imagination to trace the effect, which the stupendous fact at the knowledge of which he had arrived, would have on the progress of his favourite science ; and, it may be, the hope and the expectation occasionally arose, that the inestimable benefit he “was about to confer on his fellow-men, would secure to him some portion of their esteem and confidence. What must have been his disappointment when he found, after the publication of his tract, that the little practice he had as a physician, by degrees fell off. He was too speculative, too theoretical, not practical. Such was the view taken even by his friends. His enemies saw in his tract nothing but indications of a presumptuous mind, that dared to call in question the revered authority of the ancients ; and some of them saw, moreover, indications of a malignant mind, that conceived and defended doctrines which, if not checked, would undermine the very foundations of morality and religion. When the evidence of the truth became irresistible, then these persons suddenly turned round and said, that it was all known before, and that the sole merit of this vaunted discoverer, consisted in having circulated the circulation.” This great man, however, lived to attain, in the medical profession, the summit of reputation.

In Dr Baron’s Life of Jenner, he states, “ There cannot be a doubt that the behaviour of Dr Pearson was of any thing but a creditable character. Dr Pearson, on his examination, showed that Dr Jenner knew little about the matter of vaccination.” He states further of Dr Jenner — “ that such a person should from many receive discouragement, and meet with ridicule while prosecuting his inquiry, and be treated with disparagement, and robbed of his merits afterwards, is

Vlll

PREFACE.

too true. Yet such has always been the fate of discoverers. Such was the lot of Newton.” — Medico- Chirurgical Review, Oct., 1838.

These quotations, with the more recent attack of Dr Churchill on Dr Hamilton, will, we trust, sufficiently show that some risk is run in openly avowing a practice at variance with professional prejudice ; for if men so magnanimous have been attacked and injured by those who scarcely know what improvement means, one in our sphere, who has comparatively so little claim to extended publicity and gratitude, would, unless some precautionary steps were taken, be almost annihilated, and our name obliterated from the list of those who wish to do good.

The learned Editor of the Medico- Chirurgical Review , whose literary and medical acquirements, if equalled, are surpassed by none, must be well acquainted with these paralyzing attacks of professional men — on those whose daily aim is to improve the condition of their species ; yet he states in his review of Dr Granville’s work, “We regretted to read the following passage in the preface,” ‘ Editor.’ Dr Granville in this preface states, “ I address it (the volume) in an especial manner to the general reader, rather than to my professional brethren.” No doubt it is the desire of the worthy Editor to have things done as they should be, and unquestionably it would be an auspicious day for mankind, if professional and scientific men would acknowledge and encourage improvement from whatever source it may spring.

From these considerations then, we address our volume to every class of readers, but in an especial manner to our medical brethren, and the childbearing woman. However much our professional friends may be opposed to innovation in the practice of their art, without the sanction of some great name, we urgently ask them, simply, in the first place, to

PREFACE.

IX read and study our small volume ; then, we doubt not, they would enjoy, perhaps, for the first time in their lives, what ought always to stand high with medical men, in submitting their observations and reflections to practice, the conscientious approval of their own minds. But from the few testimonies we have quoted, as well as from our own personal knowledge, we have misgivings regarding our medical brethren. We are not afraid that the subject will be altogether neglected, for there will be always a few generous minds to espouse a good cause ; but by strong opposition, that which might prove generally beneficial in a month may require many years.

All we anxiously request of the parturient woman, and those who have a fellow-feeling with her, is to peruse these observations and cases with great care, and the self-evident facts there related will at once satisfy them regarding their truth and usefulness. We never imagine that the childbearing woman is to dictate to her accoucheur ; her only duty is to ascertain how far he is acquainted with, and fully understands a method of treatment so wrell calculated to save protracted suffering in childbearing, and at the same time obviously to lessen the risk of ill health and loss of life either to mother or child. The observations and cases under the heads, Suspended Animation and Uterine Haemorrhage, are equally important, and should be duly and deeply studied. Every accoucheur, whoever he may be, that is aware of this acquired knowledge of his patient, will endeavour to make himself acquainted with every form of information that is within his reach regarding the state of his patient. No other method that we can conceive can speedily extend the benefits of the observations to the parturient woman.

If these combinations of study, knowledge, and good feeling, co-operate in the application of the means we have

X

PREFACE.

advised, we fearlessly state that the result will be as noticed in the following observations.

Nothing but a knowledge that the accoucheur and his parturient patient have harmoniously and successfully engaged in the mode of practice we have advised, can remunerate us for the anxiety we have experienced, and the care we have taken at the bedside of the childbearing woman, for the purpose of lessening what appeared to us unnecessary suffering, and its consequences, impaired health and loss of life.

f

I CU

^Cf /K ■ . X,X

CONTENTS. \ / «✓,

\ , 5§;

Ts

XX

'ifesE,

N. iii .4

CHAP. I. Protracted Natural Labours, . . T

Sect. 1. Forms of Protracted Natural Labour, ..... 1

2. Opinions and Practice of several

Accoucheurs, ... 6

3. Observations elicited from the

4. The natural or healthy State of the

Uterus during Parturition, a $

5. The unnatural or morbid Condition

of the Uterus in Parturition, . 17

6. Symptoms that indicate the Causes

of Protraction, ... 22

7. Ruptured Uteri, . , .31

8. Treatment of Protracted Labours, 37

9. Different Opinions and Treatment, 51

II. Cases illustrative of the foregoing Observations, ...... 82

III. Suspended Animation in New-born Infants, 136

IV. Uterine Haemorrhage after the Birth of the

Child,

Sect. 1. Treatment of Uterine Haemorrhage, 166

2. Cases illustrative of Uterine Hae-

morrhage after the Birth of the Child, 173

3. Opinions and Practice of others, 190

Concluding Observations, . . 216

V. Appendix to Cases, .... 224

-

.

. .

.

. . •

.

.

-

.

I t

THE ACCOUCHEUR.

Section I . — Forms of Protracted Natural Labour

Under the designation of protracted natural labour, are comprehended those forms in which the pelvis is of such dimension and capacity, as to allow a child of the usual size to pass ; and when the presentation is of such a kind as to permit the passage by the ordinary efforts of the expulsive powers, but in which, from some other obstructing cause, the period of delivery is delayed.

When the pains, in labours of this description, continue ineffectual for a few hours, say three or four, they indicate them to be of that kind which at once come under the designation of protracted natural labour ; for though its short duration may seem not to admit of the epithet protracted, the inefficiency of the

B

THE ACCOUCHEUR.

pains characterizes the nature of the case, and calls for the employment of such means as will render the pains effective.

We will not occupy much time here to defend the propriety of embracing so many forms of labour under the above denomination, as every writer seems to use the terms which best suit his purpose, and that coincide most closely with his own peculiar views ; our object is convenience and simplicity. At the same time, it may be urged, perhaps, with some degree of propriety, that those labours in which delivery is generally effected by the usual operations, ought, without any regard to the kind of presentation or duration of labour, to be classed under the head of natural labour, though protracted.

Oardien, Baudelocque, and others, seem to entertain opinions on this point somewhat similar to our own. They do not consider the labour to be preternatural, though the nates, the feet, &e., present, provided that it terminates without the extraordinary assistance of the accoucheur.

In the definition of natural labours given by Dr Burns and others, the head presents in a certain position, and the labour does not extend beyond twenty-four hours.

According to the first authorities, any other presentation than that of the head, which is capable of passing, and does pass through the pelvis without any extraordinary assistance of the accoucheur, is classed under the head of natural labours ; but, when extraordinary assistance is required, the labour is styled preternatural.

According to the second authorities, a labour which extends to less than twenty-four hours, is classed among natural labours ; but, when it extends to a longer period, it is at once ranked among tedious, lingering, powerless, or instrumental labours, just as the imagination of the accoucheur may suggest the term he employs.

Now, it appears to us all but self-evident, that when a labour comes under the designation of natural labour, and is protracted solely from a morbid condition of the expulsive apparatus, the name should not be changed, however extended the duration of the labour may be, or whatever may be the means employed for effecting delivery; for it is incontestable that, in labours very similar to each other at commencement, some of them will, by the difference of treatment employed by the several accoucheurs, be converted into preternatural, and others into tedious or powerless labours, which, by the use of more appropriate means, might all have terminated naturally in a few hours. Therefore, the title of protracted natural labour is sufficient to characterize them, and it is improper to cover the ignorance of the accoucheur, by giving to the labour a name which warrants him at least to deprive the infant of

THE ACCOUCHEUR.

existence, and torenderprecariousthelife of the mother. No douht, the manner in which the labour terminates should be taken into account in characterizing its nature ; for instance, a. case of protracted natural labour, of so many hours’ continuance, which required the use of instruments to effect delivery. In this manner, all forms of labour which come under our designation may be sufficiently distinguished.

Strictly speaking, there are comparatively but few cases that should be ranked under the head of mere natural labours ; the great proportion of them being less or more protracted from the causes already no** ticed. In proof of this, we doubt not to be sufficiently able to satisfy the most scrupulous inquirer, that in all labours free from morbid or organic obstructing causes, delivery is effected safely, speedily, and comparatively with facility. And we trust also to be fully able to show that, in all cases of protraction, such as are under consideration, by the use of appropriate means, the causes of delay may be obviated, and the delivery effected in a few hours.

At first glance, at a department of practice apparently so limited and simple, the accoucheur will most probably intuitively conclude, that in such forms of labour, the best advice and the best remedy are patience ; and that a work pretending improvement in the management of such cases does not deserve perusal. However, let him call to mind the tedious hours

PROTRACTED NATURAL LABOURS.

be spends at the bedside of bis suffering patients, when sleep is banished from his eyes by an anxiety of mind arising from the perplexity of the case whose management he has faithfully undertaken, and he will at once acknowledge that improvement in such cases is very much wanted. But, in a particular manner, when, on reflection, he calls to remembrance the dreary hours and even days — the dreadful suffering, the imminent danger, and the fatal terminations which occasionally take place, to both mother and child in the very forms of labour under consideration-— and to the contemplation of which his most serious thoughts have been but too little directed— -he will pause, he will consider the deep obligation he lies under, to ponder well upon any mode of treatment which has for its object the averting of consequences so appalling. Moreover, in order to corroborate what we have just advanced, let him consult the records of the best conducted lying-in hospitals, as well as those of private practitioners, and he will find that the duration of severe labours, the number of women who die in childbed, and the number of still-born children, are much greater in these forms of labour than in all the others put together; and, from the same sources, he will find, that in by far the greater proportion of childbed cases, the head presents ; and that in such presentations the use of the perforator is, by several great authorities, but seldom employed. In the Maternite, at Paris, the perforator

THE ACCOUCHEUR.

was used only sixteen times in upwards of twenty thousand cases; and the celebrated Dr Dewees of Philadelphia, in more than three thousand deliveries, did not use it once. Our object at present is, not to consider the advantages or disadvantages of a practice in which the perforator is so seldom employed, but to ascertain the probable extent to which the pelvis is so narrowed that it will not allow a child of the usual size to pass ; and we consider, the two authorities we have given show, in a very unequivocal manner, that the pelvis is very seldom so narrowed that it will not allow the delivery of a living child.

Section II — Opinionsand Practice of several Accoucheurs

Dr Merriman, Dr Collins, and many others, found it necessary to employ the perforator more frequently than the above authorities. Dr Merriman in 2947 cases, used the perforator 9 times ; and Dr Collins in 16,654 cases, employed it 118 times. So frequent an application of so fatal an instrument by so distinguished an accoucheur as Dr Collins startles us not a little, particularly when we are told that it was employed more frequently than the forceps.

Although Dr Collins has put his mode of practice on record, and although it is favourably noticed by the medical periodicals ; yet we trust that neither he, nor any one else, will long continue the same course. For we trust it is satisfactorily shown above, that, in

PROTRACTED NATURAL LABOURS.

protracted labours, the cause of delay is but seldom from a narrowing of the pelvis, or an unusual size of the child ; and to show that the perforator is frequently employed, not from a deficiency in the capacity of the pelvis, but from a morbid condition of the expulsive apparatus alone, let the following suffice.

In the Midwifery Reports of the Westminster General Dispensary for 1781, by Robert Bland, M.D., it is stated, that of 1897 women delivered under the care of the Dispensary, 17, or 1 in 111, had difficult labours ; in 8 of these, or 1 in 236, the heads of the children were lessened. In a foot note it is stated, that two of the vromen whose children’s heads were lessened, had since been delivered of full-sized healthy children. This Report shows, first, the mournful extent of the destruction of infant life, and that in two cases at least the pelves were of full capacity.

Dr Merriman, in a very independent and interesting manner, gives an account of 2947 cases of labour, in which 128, or 1 in 22, of natural presentation, the labour lasted more than 24 hours. In 9 cases, or 1 in 328, the perforator was employed ; 7 times on account of distortion of the pelvis ; 2 times in very lingering labours. To what degree the distortions extended is not so much as hinted at, but from what we have stated above, and from our own experience, we can scarcely admit that they could be all of the description to prevent a child of the usual size to pass

THE ACCOUCHEUR.

with strong efficient pains. Be this as it may, two of the children’s heads were perforated on account merely of the labours being very lingering. In 21 cases, or 1 in 140, the forceps or vectis were found necessary ; and in 15 of these they were used from want of expulsive power in the uterus. Of the children brought into the world by the forceps, no other cause could be assigned for the death of three of them, than the length and difficulty of the labour. It is also stated, that from the severity of the labour, 9 cases of presentation of the nates were born dead, and 6 in feet ditto.

This statement, regarding the use of the forceps, shows they have been frequently applied ; and it deserves to be noticed, that in no less than 15 cases they were required on account of a morbid condition of the expulsive apparatus, or what is termed want of expulsive power of the uterus ; but this want of expulsive power never exists except when disease is present. In the forceps cases, and those of presentations of the nates and feet, the labours appear to have been long protracted ; and we hope to be able to show, that by an appropriate treatment, such cases may terminate very differently. It deserves to be particularly noticed, from what we have by and by to advance, that in the great proportion of 128 cases, or 1 in 22 of natural presentations, the labour lasted more than 24 hours. How many hours these labours continued, we are not told, but most probably some of them would extend to 40 or 50 hours.

The individual who gives so excellent an account of his experience in private practice, deserves well the thanks of the profession. And we are of opinion, that were every accoucheur, who has charge of a lying-in hospital, obliged, by the laws of the institution, to publish annually a report of the cases delivered under his care, similar to the method so well executed by Dr Collins of Dublin, it would be generally useful.

By the above few remarks and extracts, we have endeavoured to show, that the great portion of the accoucheur s time, and the parturient womans s offer - ings, are connected with the forms of labour which we are at present considering; and that the necessity for the use of instruments, in so many deliveries of so fatal a description, is occasioned by other causes than a narrowing of the pelvis, or unusual size of the child ; and that these causes, we hesitate not to affirm, are aimost always confined to the expulsive apparatus themselves, and are remediable.

But, as gentlemen of great and deserved celebrity differ widely in their opinions regarding the propriety and impropriety of interference in protracted labours, when there is no present danger; we shall notice a few of those whose views deserve to be known.

Dr Denman states that “ no person in labour ever had a pain depending on her labour which was in

b 2

THE ACCOUCHEUU.

vain.” This statement certainly cannot be correct ; for after labour pains have ceased to advance the child, they continue to exhaust the woman, and render delivery by instruments necessary. All those pains, therefore, subsequent to the commencement of exhaustion, must have been worse than in vain — they must have been pernicious. Again he says, “ whether the labour pains produce an immediate effect or not, it is our duty to wait with patience, provided there be no tokens of danger.” This advice can only be admitted as a good one, when it is shown in a satisfactory manner, that no means can be used to improve the nature of such pains ; this however is not done.

In regard to the dilatation of the os uteri, he states, “ Whether a long or a short time be required for this purpose, it is the duty of the practitioner to abstain from interfering in this part of the process.” Drs Hamilton and Burns have shown, we think, beyond all doubt, that interference is particularly called for in such cases, and proves serviceable ; and we trust we shall be able to put it still farther beyond dispute. On the topic of difficult labours, Dr Denman remarks, “ no means of improving these pains can be depended on.” It is true, that to this day, many seem to hold the same opinion ; but nothing can be more erroneous, for in no department of the medical art is there a greater certainty of success, than in that of improving the pains in obstinate labours.

Dr Burns acutely remarks, that were there no obstructions to the full operations of the uterus, labour would not be protracted ! One would think that a mind so constituted as to announce a fact so brilliant, would have intuitively suggested a probable or certain means of removing such obstructions ; but from what he states, even in the last edition of his Midwifery, it is clear that he has not yet made a very near approach tu a full knowledge of those remedies which should be employed for their removal. His words are, “ Some women seem constitutionally to have lingering labours, and in such cases, generally, it is neither useful nor proper to do more than encourage the patient, or preserve her strength.”

Dr Ramsbotham observes, “ It appears to me that labour pains (properly so called) were intended by the Great Creator of nature, for the wisest purposes and a little farther on he states, “ they ought not, generally speaking, or on the application of a general principle, to be meddled with. I have,” says he, “ my doubts whether, except in very rare instances, any attempt should be made to palliate them.” These are extraordinary views to be held and promulgated in these days of improvement, by an accoucheur, possessed of public confidence, and having so many of the lives of his fellow-creatures, without control or responsibility, submitted to his care.

It is true, a man is always justified, particularly in

THE ACCOUCHEUR.

matters of importance, when giving his candid opinion ; but no man ought ever to express the views he has formed on a subject to which he has given but little consideration : which seems to be the case in the present instance, at least as regards a knowledge of this part of obstetrical practice ; for it is evident, that if Dr R. had any thing like a clear idea of the nature of inefficient and exhausting pains, which less or more take place in all protracted labours, he would never have employed language to impress on the minds of others, a mode of proceeding directly contrary to what at least we have found universally advantageous ; that is, the application of means for the relief of frequent, but ineffectual labour pains. And we entertain no doubts whatever, that the merest tyro, at his first and imperfect trials of the means we shall by and by point out, will corroborate our statement.

Dr Breen does not denominate the labour tedious, till thirty hours have elapsed from its commencement. Should this worthy Dr intend any important alteration, either good or bad, after changing the name of the labour to that of tedious, certainly no one can accuse him of alarming his poor suffering patient, by hurriedly informing her, that the name of her labour is now changed, having continued thirty hours ! Such an announcement could have no effect in assuaging the torturing pains of thirty hours’ duration ; and had the Dr employed his time less in uselessly fixing the

PROTRACTED NATURAL LABOURS.

periods and names of labours, and applied it more assiduously in ascertaining the means suited to the prevention of the extension of labours to so frightful a duration, it would be more consoling to the parturient woman.

Dr Merriman makes some good remarks on protracted labours, but recommends nothing on which he places dependence for promoting the delivery within a given time.

Section III.- — Observations elicited from the above

From the views and observations of the authorities just mentioned, we would be led to conclude, that the fate of the childbearing woman, in regard to the duration and violence of her labour, was in a great measure fixed by Divine edict. Now we expect to be fully able to show, that the protracted sufferings of the parturient woman arise from incidental morbid causes, and have nothing to do with the sacred declaration of the Great Creator. And, moreover, that these morbid causes are more under the control of remedial means, than any other violent and dangerous disease to which mankind are liable.

The ambiguity and pernicious consequences which often arise in attaching meanings to terms and expressions wdiich do not belong to them, can seldom be more conspicuously met with, than in the Scripture phrase,

“ in s6rrow thou shalt bring forth children.” That protracted suffering in child-bearing, would be the lot

THE ACCOUCHEUR.

of fallen woman, is not so much as even implied in this declaration. And, indeed, were it so expressed, the truth, that the Great Creator was its author, might well be questioned ; for who could for a moment suppose, that He who created all things so admirably to fulfil the end intended, would construct and destine the uterus to act differently from other organs somewhat similarly circumstanced in their operations: the bladder and intestines receive, retain, and expel their contents with regularity and facility, and when the contrary takes place, disease is to some degree present. Besides, had the decree gone forth, that women in childbed would be tortured for hours and days with unmitigable pains, there would be some approach to a similar suffering in all ; but we know that this is not the case, for many women have short and comparatively easy labours, yet who would presume to say that these women had not sorrow in childbearing. Days and nights are always, in some degree, spent in silent contemplation by every pregnant woman, respecting her great and approaching crisis, and the first thrill of pain, intimating the commencement of labour, pervades with unique impulse, every limb, every nerve — the very soul itself.

Section IV. — The natural or healthy state of the Uterus

during Parturition.

Having made these few preliminary observations, we shall proceed, for the sake of connexion, to consider the natural state of the uterus during parturition.

Even in the fallen condition of man, it is evident that he is naturally free from disease though subject to it. In this wholesome state, all his organs seem to perforin their functions with efficiency. Thus the uterus, in the parturient woman, effects delivery in that expeditious and uniform manner, which is observed by the other organs of the body, in the performance of their multifarious functions. This organ, by its own native powers, receives, retains, and ultimately expels those contents on which it is destined to operate ; and these various processes are performed with a regularity and effect, which are always the result of those operations carried on under the influence of the uninterrupted laws of nature.