Obstetric clinic: a practical contribution to the study of obstetrics and the diseases of women and children

Front matter

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A PEACTICAI COUIEIBUTIOS TO THE STUDY

OBSTETRICS, AND THE DISEASES OF WOMEN AND CHILDREN.

Preface

DuEixa a service of fourteen years in Bellevue Hospital, it has been my constant endeavor, by clinical instruction, to make my advantages available for others ; and I have pubhshed many cases which interested me most deeply, and especially such as terminated unfortunately, both in medical journals and in papers read before the 'New York Academy of Medicine and the State Medical Society.

At the commencement of my service in Bellevue during, April and May, 1867, 1 determined that the most interesting cases should serve as the basis for a volume, in which should be interwoven the substance of such clinical remarks as were then made to the class in attendance, with such other practical hints as might naturally suggest themselves during the preparation of the work ; but that the great aim of the book should be, to illustrate my views with the cases which had accumulated on my hands, or had been published in journals now discontinued, and not very available for reference.

Such a course has allowed me to adopt the style and phraseology of a lecture whenever the character and extent of the subject permitted; and has led me to place those cases treated in the designated service, at the commencement of the chapters, where they serve as texts.

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PREFACE.

The cases thus collected represent faithfullj the difficulties, anxieties, and disappointments inseparable from the practice of obstetrics, as well as some of the successes for wliicb we are entitled to hope in these arduous and responsible tasks. Thej illustrate debatable and elective methods of treatment, and may therefore contribute to the establishment of laws as yet undecided. They supply a large number of facts in elucidation of the relations of albuminuria to pregnancy, and demonstrate alike the unexpected difficulties and the unexpected ease which may mark the performance of obstetric operations.

"While available, therefore, for critical analysis, their fulness of detail may render them of value for the student and the practitioner. The clinical remarks represent succinctly, but fully^ my own views of practice. For the facilitation of reference, a very copious and carefully prepared index has been added.

I have also taken this opportunity to republish the results of the study of kyestein by the late Dr. Henry Yan Arsdale and myself, as the paper has not been so accessible to the profession as we had desired ; and as the lapse of time and further observations have convinced me of the correctness of our conclusions.

Finally, the work is presented as a partial discharge of the debt due to the profession by all who enjoy hospital advantages ; and in grateful recognition of the benefits which the author has derived from the recorded experience of others.

Chapter I. Eelations Of Albumestueia To Peegnanoy

Case: Bright's Disease. — Case: Induction of labor for albuminuria, and diminution of the urine. — Puerperal albuminuria and eclampsia. — Frequency of albuminuria in the puerperal state. — Relations of albuminuria to pregnancy.— Case: Cardiac disease; albuminuria; oedema of lungs; forceps; suppression of urine. — Case : Albuminuria ; uterine fibrous tumors ; rigid OS; douche; incision of cervix; forceps. — Case: Albuminuria; miscarriage; great jactitation. — Case: Puerperal eclampsia; albuminuria ; manual dilatation of cervix ; douche ; Barnes's dilator. — Physiognomy in albuminuria. — Case: Bright's Disease. — Case: Albuminuria; eclampsia; forceps. 1

Chapter II. Peophtlaxis Op Pijeepeeal Eclampsia.- Oonvulsions

-YAEIETIES OP PUEEPEEAL

Prophylaxis of puerperal eclampsia. — Case: Puerperal eclampsia; profuse salivation from a mercurial purge. — ^Purgatives ; diaphoretics ; acids ; diet. — Case: Albuminuria; puerperal eclampsia. — Induction of labor as a • prophylaxis. — Case: Puerperal eclampsia; induction of labor; Barnes's dilators; forceps. — Case: Albuminuria in pregnancy. — Case: Puerperal eclampsia; induction of labor. — Case: Albuminuria and eclampsia in the first confinement ; albuminuria and induction of labor in the second by the douche. — Case : Puerperal eclampsia ; induction of labor ; Barnes's dilators ; douche; forceps. — Varieties of puerperal convulsions. — Case: Puerperal convulsions; no renal disease; consciousness not abolished; douche. — Case: Hysterical convulsions and hemiplegia. — Case: Poisonous efiects of an infusion of stramonium-leaves, injected in the rectum. . . .33

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Chapter III. Ohloeofoem And Texesectiox IX Pueepeeal Eclampsia

Chloroform in puerperal eclampsia. — Case: Alarming symptoms from chloroform in a natural labor. — Case: Alarming symptoms from sulphuric ether in an operation for urethro-vaginal fistula. — Chloroform in cardiac disease and syncope. — Case: Syncope after labor, and subsequent history. — Case: Powerless labor; delay; cardiac murmur; ether; forceps. — Case: Amylene. — Venesection. — Case: Puerperal eclampsia ; venesection. — Case: Puerperal eclampsia; forceps. — Case: Puerperal eclampsia; forceps. — Case: Puerperal eclampsia; no albumen; forceps. — Case: Puerperal eclampsia; venesection; cups; chloroform. — Case: Puerperal eclampsia; venesection; cathartics; forceps. — Case: Puerperal eclampsia; chloroform; cups; forceps.— Case: Puerperal eclampsia; cups; chloroform. — Case: Twins; eclampsia; chloroform; purgatives; cups. — Case: Puerperal eclampsia; mania. — Case: Puerperal eclampsia; chloroform; cathartics; emetics; venesection. — Case: Puerperal eclampsia; no albumen. — Case: Puerperal eclampsia; forceps; normal dilatation. — Case: Puerperal eclampsia. — Case: Albuminuria; intra-uterine hydrocenhalus. — Case: Bright's disease; puerperal eclampsia; chloroform; Barnes's dilators. — Case: Albuminuria; eclampsia; death before dehvery. — Case: Albuminuria; eclampsia; death from apoplectic clot with atheromatous degeneration of vessels. — Case. Albuminuria; eclampsia. — Case: Albuminuria; induction of labor ; mania; subsequent history. — Case: Albuminuria; eclampsia; induction of labor. — Case : Albuminuria ; eclampsia ; induction of labor ; craniotomy. . 63