A SELECTION 
OF 
REMARKABLE CASES 
OCCURRING IN A 
PRACTICE OF EIGHTEEN TEARS. 
BY E. N. CHAPMAN, M.D., 
PROFESSOR OP THERAPEUTICS, MATERIA MEDICA, AND CLINICAL OBSTETRICS 
IN THE LONG ISLAND COLLEGE HOSPITAL, 
BROOKLYN, N. T. 
[Reprinted from the Philadelphia Medical and Surgical Reporter.] 
PHILADELPHIA: 
KING & BAIRD, PRINTERS, No 607 SANSOM STREET. 
1 8 68. CONTENTS. 
Polypus Uteri 1 
Polypus of the Canal of the Cervix Uteri 5 
Polypus of the Canal of the Cervix Uteri, producing Congestion, Procedentia, and 
Menorrhagia 5 
Urticaria 5 
Eclampsia Nutans 6 
An Anomalous form of Convulsions Y 
An Abscess in the Muscular Wall of the Uterus 8 
Fracture of the Femur by the Muscular Contractions of the Uterus in a Natural 
Labor . 9 
Elongation of the Neck of the Uterus 11 
A Secretion of Milk, and Yulvar Haemorrhage in New Born Infants 18 
Haemorrhage from the Genital Organs of Female Infants 14 
Hydrocephalus Chronicus 15 
Procidentia Uteri during' Gestation 15 
Spontaneous Evolution (Pelvic) 16 A SELECTION 
OF . 
REMARKABLE CASES 
OCCURRING IN A 
PRACTICE OF EIGHTEEN TEARS. 
E. N. CHAPMAN, M. D. 
PEOF. OF THERAPEUTICS, MATERIA MEDICA, AND CLINICAL OBSTETRICS IN THE LONG ISLAND COLLEGE 
HOSPITAL, BROOKLYN, N. T. 
[Reprinted from the Philadelphia Medical and Surgical Reporter.] 
polypus uteri. 
became natural, and the digestive organs re- 
gained their natural condition. Nevertheless, 
a hidden cause of irritation remained undis- 
covered, as was manifest from the profound 
implication of the nerve-centres, and the rapidity 
of the pulse; which, throughout her sickness, 
remained constantly above 100 per minute, and 
from augmented sufferings, many times, rose to 
ISO. The uterine symptoms were not relieved, 
but rather increased and intensified. These were 
a profuse haemorrhage, attended with pain of a 
grinding cutting character, that was agonizing, 
very persistent, and with difficulty subdued, 
unless by large doses of anodynes; and an 
elastic tenseness and acute tenderness in the 
region of the left ovary, extending somewhat 
above the pubic bones, but not to other portions 
of the abdomen. On tactile examination by the 
vagina and rectum nothing could be discovered 
that afforded a single ray of light in the dark- 
ness surrounding the disease. The peculiarity 
of the pain experienced by the patient indicated, 
that the womb contained a formation of some 
kind, wdiich was constantly inciting it to con- 
tract for its expulsion ; though the fibrinous 
coagula, that appeared to be constantly forming, 
On the 13th of August, 1855, I was called to 
see Mrs. D , a young English woman, twenty 
years of age, who had been married for four 
months. Her marriage took place during 
menstruation, and, at that time, her illness com- 
menced. Hitherto she had always, in a remark- 
able degree, enjoyed good health; and rarely, in 
her life, taken medicine of any kind. 
I found that she was feverish, and suffering 
from nausea, and a feeling of oppression at the 
stomach; and that the menses, present two out 
of the four weeks, were attended with a profuse, 
exhaustive flow and great pain, similar to that 
from dysmenorrhoea. 
Our first impression was that the uterine dis- 
charge was due to the impeded circulation in the 
vena portse, which occasioned a congestive con- 
dition of the other abdominal viscera; and that 
a speedy relief from this complication would 
follow a proper attention to and cure of the 
hepatic derangement. On this assumption she 
was treated with mercurials, until a slight con- 
stitutional effect was evinced, by the tenderness 
of her gums; when gradually, the yellowness of 
the skin disappeared, the hepatic secretion | 2 
yet only occasionally expelled, whenever the suffej- 
ing was most severe, seemed sufficiently to account 
for the symptoms, without assuming the pres- 
ence of a polypus, which I was unable to detect. 
In the treatment hitherto followed, we had, 
unwittingly, confounded cause and effect; and 
directed our efforts to the removal of a result 
rather than the source of the disease. The 
jaundice, as at this stage seemed clear, must 
have been symptomatic of irritation in the gene- 
rative organs; yet, after narrowing down the 
range of our investigations to so small a circle, 
the great difficulty lay in the fact, that it was 
impossible to fix, with certainty, upon the exact 
structure implicated, or the morbid changes 
that had and were now taking place. In our 
doubts, from the difficulty of otherwise solving 
the significance of the symptoms, and the appa- 
rent lack of other causation ; we now adopted 
the view, that there existed an inflammation of 
the left ovary and treated the case for two and a 
half weeks with diaphoretics, anodynes, fomen- 
tations, leeches and blisters with no better result 
than at first. 
Dr. E. J. Tilt (Diseases of Menstruation and 
Ovarian Inflammation) maintains, from clinical 
experience, that the ovaries bestow, exclusively, 
on women her special organization; that all 
disorders, peculiar to her, originate, sympathet- 
ically, from this source ; that the uterus is 
merely a receptacle provided for the sojourn of 
the foetus for a limited period; that the uterus 
is wanting, entirely, in those vital relations and 
extensive sympathies universally attributed to 
it; and that its diseases are simply results of 
ovaritis, only curable by attacking the primary 
disease. 
These doctrines of Dr. Tilt; I would remark, 
en passant, have not been confirmed by my 
experience in later years, although it has been 
somewhat extended; and I should say that, in 
my opinion at least, uterine disease rarely owes 
its origin to this source. 
The patient had now been under my charge 
for more than six weeks ; during which time the 
uterine symptoms—a more abundant flow, 
severer pelvic pains, greater tenderness, hard- 
ness and swelling above the upper rim of the 
pelvis—had, gradually, become more urgent. 
The catamenia invariably appeared on the day 
for their recurrence, at first natural, fluid, mode- 
rate in quantity, and attended with little or no 
pain for two or three days ; then gradually they 
became haemorrhagic, very profuse, clotted and 
accompanied with pains resembling, exactly, the 
throes of labor. The discharge, remaining thus 
at its height for several days, would slowly sub- 
side and eventually cease; when an interval of 
three or four days would follow, in which there 
would be almost a complete immunity from suf- 
fering ; and slight evidences of a fixed disorder, 
excepting the inroads made on the constitution, 
observable on such occasions, most palpably. 
The patient would express herself as feeling 
almost well; and, frequently, would be up, and 
attempt to do some light work; but yet, her 
pulse, as before mentioned, was uniformly hard, 
corded and above 100 per minute. 
As, on repeated examinations by the 'touch, 
nothing was discoverable to aid me in solving the 
mystery enveloping the case; I succeeded, 
after much hesitation and delay on the part of 
the patient, in gaining her assent to the employ- 
ment of the speculum. Her scruples were only 
overcome after enduring two periods of fearful 
drainage, that produced great exhaustion, and 
placed her life in imminent peril. This means 
of investigation, however, afforded no additional 
information, and only revealed a puffy state of 
the neck, and a patulous condition of the mouth 
of the womb. No morbid growth could be seen, 
and by using the sound, none could be discov- 
ered in the uterine cavity. At this result, I felt 
much disappointment; since, at this stage, the 
peculiarity of the symptoms indicated the pre- 
sence of a polypus; and I was forced to conclude 
that it was too small, if it had an existence, to be 
perceptible. Keviewing the whole history of 
the case, it seemed highly probable that there 
was an inflammatory state of the lining mem- 
brane of the uterus; since, several times, on 
using the speculum, a small fibrinous clot was 
expelled into its cavity. Any way, without 
feeling over confident in this new supposition, 
I resolved to make another attempt for her 
relief, knowing that if a polypus was forming I 
should be obliged to wait for its development. 
Once or twice, during the inter-menstrual 
period, I introduced into the cavity of the 
uterus, by means of a bit of sponge attached to 
a whale bone, a strong solution of lunar caustic. 
During the flow, cold water was used externally, 
and by the rectum ; and, whenever the pain was 
excessive, anodynes were given. Every effort 3 
was made by tonics, stimulants and a nutritious 
diet to add tone to her nervous system and the 
elements of nutrition to her blood; both of 
which had been exhausted by the continuance 
and severity of the haemorrhage. This course 
was followed with slight variation to the 18th of 
February, 1856, when the patient moving to 
New York, passed from my hands. 
There was the most marked improvement in 
all her symptoms; in her general appearance 
and strength; in the discharge which was fluid, 
and scarcely one quarter of its former amount; 
in the pain which was more of a weakness and 
uneasiness than an expulsive effort, and in the 
relief from the flow which, progressively shor- 
tening in its continuance had been absent for 8 
to 12 days at a time. It appeared to me then,— 
an opinion which I am still disposed to hold,— 
that endometritis existed from the first; and 
that a plan of medication to subdue the inflamma- 
tion would have successfully met the haemorrhage, 
and prevented the formation of a polypus; which 
eventually arising on this inflamed base gradu- 
ally monopolized the nervous and vascular sup- 
ply of the part, and thus cured the original 
disease by the simple process of one supplanting 
another. 
As, on removing to New York, the patient 
became worse again in two or three months, her 
husband, by the advice of friends, was induced 
to try the other system—so-called—of medicine. 
A gentleman versed in the sibylline books, and 
oracular in this modern mystery, so vauntingly 
proclaimed, as though it possessed a talismanic 
potency which would attain results, as by magic, 
by inconceivable, material agencies, was called 
to administer to her necessities. He, with an 
infinite faith in his infinite attenuations, nothing 
doubting, assailed the enemy boldly by heavy 
and continuous discharges from his liliputian 
artillery. Incredible to relate, this system— 
that never fails and which, with a fair start and 
a clear field, can conquer the great Conqueror of 
all flesh—now, for a reason not very apparent, 
receives a check; nay, I may say, is discomfited. 
Nothing daunted, however, other wise men are 
summoned in counsel, one after another, until 
five, learned in the divisibility of matter, and in 
the interpretation of the inarticulate mutterings 
of the Anima or Archmus inhabiting the body, 
united their wisdom in a grand sum total, and 
simultaneously made fearful onslaughts on their 
common enemy with the same ill success. Hav- 
ing exhausted their armamentarium medicum, 
or rather having exhausted the patient in 
their pursuit of symptoms, by new method of 
warfare, they resumed their old fashioned wea- 
pons, which, being somewhat rusty, did little or 
no execution—at least for good. At length, 
after a trial of eight months, they ventured an 
examination, which revealed to them a large 
body filling the vagina, to which they were sadly 
puzzled to give a name. In their doubts, a 
surgeon from the regular profession is sum- 
moned to their aid; a person of repute in the 
art, though, I am sorry to say, with a character 
that must ever be tarnished by such company. 
In a period of four months eight examinations 
were had, whilst the patient was under the 
influence of chloroform; when, finally, the con- 
clusion was arrived at, that the tumor in the 
vagina was an inverted uterus; which, it was 
proposed, to remove by ligation, an operation, 
in their opinion, feasible and attended with little 
hazard. 
Mrs. D. came to visit a friend in this city for 
a few days, with the intention of learning my 
views in regard to the disease, and the propriety 
of its removal by an operation. On the 2d of 
September, 1857, I received a message to call 
on her, immediately, as she was in a dying con- 
dition from the loss of blood. I found her faint, 
speechless and blanched by a sudden and profuse 
haemorrhage, amounting to at least sixteen 
ounces, which took place in a short time, with 
pains like those of labor. For fear of re-excit- 
ing the flow that had ceased on my arrival, a 
slight examination was made; only so far as to 
reveal a large body filling the pelvis to its utmost 
capacity, pressing down on the perinmum, and 
sensitive, apparently, to the touch. A few days 
use of tonics and stimulants having revived her, 
a more thorough exploration was instituted. 
Mrs. D. stated, that, after her removal to 
New York, she continued, for a time, much as 
before; then by degrees lapsed into a state of 
flooding, profuse and nearly constant, but event- 
ually of a paroxysmal character;—a sudden gush, 
. generally copious, with uterine contractions,— 
: when it would cease for longer or shorter inter- 
i vals. The change in the mode of the discharge 
i was satisfactorily accounted for by the tampon- 
-1 like body distending the vagina. 
At all times there was a persistent expulsive 4 
tenesmus, and cutting, lancinating pains through- 
the sacrum and pelvis, that kept up a constant 
state of lingering agony ; in fact, the pains of a 
quasi labor were rarely absent, and reached their 
acme when the hmmorrhage was most copious. 
As before stated, there was found in the 
vagina a large body, pyriform in shape, with its 
larger extremity downward ; filling the pelvis 
completely, and crowding itself upward to the 
height of the superior strait, downward on the 
floor of the pelvis and backward on the rectum. 
Without the aid of injections, faeces or flatus 
even could not be passed; and generally, though 
these were used, great difficulty was experienced 
in relieving the bowels. 
By a considerable degree of force the finger 
would pass each side of the tumor; except 
posteriorly, where it pressed down on the peri- 
nceum much like a child’s head in parturition. 
In front, by the strongest pressure upward, it 
was barely possible to touch, but not very accu- 
rately or definitely, a substance firmer than the 
mucous membrane, with which however it seemed 
a part; but to either side it could not be de- 
tected. By drawing back the perinaeura a good 
view of the lower surface of the tumor was 
obtained. It had a red, velvety look, like the 
mucous membranes in a state of congestion ; 
was coated with a copious secretion of mucus, 
and traversed by large blue and red vessels ; in 
fact, its shape and appearance were such as 
would be presented by an inverted uterus. Be- 
sides, as she asserted, the tumor was sensitive— 
the gentlest touch being appreciated and rough 
handling causing pain—though of this fact I 
could not, satisfactorily, assure myself; since the 
patient’s sacral nerves, from long-continued irri- 
tation, were super-excitable, as yve observe in 
neuralgia; and any pressure on the tumor would, 
from its accurately filling the pelvis, be felt in 
all of the contiguous structures. 
On the 24th of February, fortified by the aid 
and counsel of two professional friends of large 
experience, 1 went prepared to make a thorough 
exploration; and, if a polypus was diagnosticated, 
to apply a ligature to its pedicle. The tenes- : 
mus, that was always excited by an examination, 
being removed by the use of chloroform ; it was 
possible to feel more accurately the firm rim 
above mentioned and trace it, though imper- : 
fectly, to either side. The sound, introduced ; 
along the finger, passed three quarters of an ; 
inch, anteriorly, beyond this firm border; and 
when pressed, laterally, entered from two and a 
half to three inches. Hence I concluded that 
we had to deal with a polypus, whose insertion 
was on the anterior walls of the uterus ; since, in 
a case of inversion, even though partial, it 
would be impossible to pass an instrument so 
far within the os uteri. 
Unfortunately this diagnosis, in which I was 
most decided and positive, was not concurred in 
by the consulting surgeons; one being equally 
decided and positive that there was a complete 
or, more probably, a partial inversion ; and the 
other uncertain, though in the main inclined to 
my view, more from the difficulty of understand- 
ing how a virgin uterus could be inverted than 
from any information afforded by the exami- 
nation. 
Having spent nearly three hours in exploring 
and comparing opinions, I was advised to apply 
the ligature, in case no doubt or misgiving 
remained in my mind, and I was prepared to 
assume the responsibility. This I felt embold- 
ened to do; both by my confidence in the ex- 
istence of a polypus, and by a previous request 
of the patient; who entreated me to venture 
upon any procedure however hazardous, that 
promised relief; as life to her with such suffer- 
ings was a burden. Moreover, it was apparent, 
even to the unprofessional observer, that her 
constitution could not much longer bear up 
under these profuse hemorrhages; and that 
death was approaching, with a steady, even step, 
unless a risk was assumed by some one for her 
preservation. 
I employed Profs. Campbell & Yan Buren’s 
modification of Gooch’s double canula. This 
instrument,—which may be found figured in 
Gardner’s translation of Scanzoni—from the 
ligature being tightened by a screw, immediately 
strangulates the polypus and thus expedites very 
materially the ulcerative process; by which 
means, the irritative fever is lessened and the 
danger of purulent absorption obviated. The 
ligature, a double strand of saddler’s silk, was 
applied around the pedicle with less difficulty 
than was anticipated; and, in less than ten 
minutes, the operation was completed. 
The patient experienced little inconvenience 
for the first two days; but on the third and fourth 
she sank very low with an ataxic fever, that was 
attended with a muttering delirium, a most 5 
alarming prostration and a discharge, in large 
quantities, of foetid pus; symptoms, that boded 
a serious result, had they not been quickly 
relieved by the polypus becoming at this junc- 
ture detached. Its remains consisted of fasci- 
culi of muscular fibres resembling the column® 
came® of the heart; and, though much the 
larger portion had sloughed, was of a size one 
half larger than a goose egg; whence we con- 
clude that, originally, its bulk must have equalled 
that of the head of an eight months’ foetus. 
I am happy to state, that, though more than 
seven years have since elapsed, our patient con- 
tinues to enjoy uninterrupted health, and is not 
annoyed with any abnormal uterine symptoms; 
but yet, much to her sorrow, her marriage 
remains unblessed. 
its normal state, as was verified by observation ; 
and the woman’s health is thoroughly re-estab- 
lished. 
This lady, for five years, had suffered from a 
profuse menorrhagia, and was rarely free more 
than eight days in a month from a bloody dis- 
charge. However long her periods continued, 
and however excessive they might be, they inva- 
riably returned at the appointed time. By this 
persistent drainage she had become greatly 
debilitated and very anaemic. 
POLYPUS OF THE CANAL OF THE CERVIX UTERI PRO- 
DUCING CONGESTION, PROCIDENTIA AND MENORR- 
HAGIA. 
A woman, of about forty years of age, pre- 
sented herself at the College clinic during the 
last session, with a procidentia uteri, that had. 
troubled her for more than two years, producing 
tenesmus, and a feeling of dragging and pressure, 
and attended almost constantly, with a san- 
guineous discharge, which often was profuse. On 
inspection, the neck of the uterus—swollen and 
chafed—was found protruding externally; and 
the inner neck, just within the os externum, had 
a polypus no larger than a pea hanging from its 
surface. The menorrhagia ceased, and the con- 
gestion diminished, when I had removed the 
polypus by torsion; and the patient’s unpleasant 
sensations were so much relieved by the opera- 
tion, and by wearing a piece of sponge, which 
after introduction was wet by injections of alum 
water, that she declined the employment of a 
globe pessary, to prepare for which these means 
were instituted. 
POLYPUS OF THE CANAL OF THE CERVIX UTERI. 
During the spring of the present year a case 
of polypus uteri came under my care, that was 
interesting from the peculiarities presented, on 
examination either by the finger or speculum. 
These, though not very singular, and, in my 
opinion, frequently observed under the same 
conditions, might mislead others into a false 
diagnosis; as was the case, in this instance, with 
an obstetrical teacher, who, the year previous, 
had the lady under charge, and declined to 
operate, as alleged, by reason of the number of 
polypi embedded in the neck of the womb. By 
the touch the canal of the neck was felt to flare 
open from the inner os, which was closed; and 
to be studded with prominences, that were 
separated by deep sulci. By the speculum a 
small mucous polypus, pedunculated and the 
size of a pea, was seen attached just within the 
outer os; and, lining the inner neck, were irreg- 
ular projections, that resembled fibrous polypi, 
growing, without pedicles, from the uterine 
tissue. This appearance, I had no doubt, re- 
sulted from the increased nutrition of the rugosi- 
ties ; (the markings between which, form what is 
called the arbor vitae) which, from the congested 
state of the uterus, had become greatly enlarged; 
and I expected, that when the polypus, the cause 
of the preternatural flow of blood, was removed; 
the surrounding parts would return to their 
normal condition. The operation was done by 
torsion. The succeeding menstruation was ex- 
cessive; but this function, has since been natural; 
the cavity of the uterine neck has returned to 
URTICARIA. 
Mrs. P—, a patient of mine for the last sixteen 
years, is the subject of a singular idiosyncrasy ; 
and also of a peculiar functional disorder of the 
nervous system. She is fifty years of age, of a 
delicate organization, and nervous temperament; 
and has never had much ill-health, other than a 
feebleness of constitution; which, at times, re- 
quires her to resort to tonic medicines, more 
especially, vegetable bitters. 
The idiosyncrasy is remarkable. The eating 
of strawberries, however few in number, affects 
her most violently. She is seized with the se- 
verest form of cholera morbus; has repeated 
turns of fainting; is prostrated profoundly, as 
though by a poison, and covered over the entire 6 
surface of the body with the wheals of urticaria;' 
which, being attended with unusual irritation, 
cause great swelling, particularly of the face, by 
which the eyes are closed. What renders this 
peculiarity more striking, is the fact, that no 
other kind of food will awaken this train of 
symptoms. 
After a few lessons in early life she learned to 
avoid this fruit, and no temptation induced her 
to taste it, until many years afterward ; when 
she was persuaded, through the ridicule of her 
friends at such foolish whims, to take three gar- 
den strawberries on trial. The result was a 
repetition of the experience of her childhood. 
All of the old symptoms, in less than half an 
hour, presented themselves in their dormer se- 
verity; and, continuing for two days, reduced her 
very much. It was more than a week before 
she regained her ordinary health. Since this ex- 
periment Mrs. P. has never lost faith in her own 
'provings, nor forgotten her trials in strawberries ; 
though these run counter to, and are in the face 
of, the universal experience of mankind. 
This lady’s father and his brother were affected 
in a similar manner, but none of the other mem- 
bers of his family; and her children, of whom 
there are three, use this fruit without suffering 
any inconvenience. 
It should be mentioned, in addition, as another 
evidence of the-peculiar impressibility of this 
person’s nervous system ; that, whenever, she is 
brought into the neighborhood of newly mown 
hay, an attack of asthma is excited. From these 
attacks, which have been rather frequent, a 
chronic catarrh, has been super-induced; that 
renders her the subject, almost constantly, of a 
cough; but the asthma does not arise except 
from the peculiar influence to which she is sus- 
ceptible. 
that the essential characteristics—the distinctive 
symptoms—peculiar to these disorders are lack- 
ing. 
The lady, when seventeen years of age, be- 
came greatly alarmed at the sight of a large fire 
in close proximity to her father’s house ; and then, 
for the first time, several paroxysms of these 
convulsions, that have since followed her, showed 
themselves in succession. In after life, their re- 
currence was very variable ; usually, there would 
be a respite for weeks, more especially in cool 
and bracing weather, as her appetite and diges- 
tion were better at this season; but often she 
would have many attacks in a day, even from 
twenty to thirty, particularly if she was suffering 
from any illness, or the tone of the nervous sys- 
tem was lowered by mental or bodily depression. 
In this latter condition the most trivial causes 
excited a paroxysm ; a hasty word, disagreeable 
news, the ringing of the door-bell, an unexpected 
call of a stranger, etc. My first professional 
visit was signalized by one of these marked de- 
monstrations, that startled me by its sudden ap- 
pearance and singular nature. 
The convulsive movements commence without 
premonition. A deathlike feeling at the epigas- 
trium is immediately followed by a rapid beating 
of her knees with the open hands with irregular 
alternate strokes, by a simultaneous stamping, 
in the same manner, of her feet, which are turned 
inward, resting on the outer edge, and by a se- 
ries of bowings of the body but more markedly of 
the head as in a salutation, in unison, more or 
less imperfect, with her hands and feet. These 
movements of the head and body are attended 
by similar ones of the thighs which are flexed by 
like motions. From the peculiar shape her per- 
son thus assumes, she never falls while sitting, 
though in a rocking chair, but seems to be 
fastened in her position by the nature of the 
muscular spasms. These, which are completely 
beyond the control of the will, unaccompanied 
by a loss of consciousness, and never varied in 
character, so that one is a perfect type of all 
others; continue for about two minutes, when 
suddenly a complete relaxation follows. Now 
she experiences a feeling of exhaustion, from 
which, however, if the convulsions are at an end, 
she promptly recovers and regains her natural 
condition ; and even, as I have witnessed, resumes 
the conversation that had been momentarily 
interrupted. 
ECLAMPSIA NUTANS. 
This lady is, likewise, affected with an aberra- 
tion in the function of the nervous system, more 
singular than the idiosyncrasies just mentioned; 
which I shall venture to rank under the head of 
Eclampsia Nutans, or Salaam Convulsions; 
though in doing so, I may, perhaps, leave my 
diagnosis open to criticism. The description of 
the remarkable features of the case, will convince 
the reader, that there are, at least, only two 
other diseases—Chorea and Hysteria—to which 
the phenomena presented can be ascribed ; and, 7 
Though Mrs. P., has been affected in this 
manner for thirty-three years, the attacks are not 
more severe or frequent; nor are any ill-effects 
discoverable. Her memory and intelligence are 
unimpaired, and her health and strength have 
suffered no serious inroads, other than what are 
incident to advancing years, although these con- 
vulsive paroxysms must be numbered by hun- 
dreds ; in short, neither her mind or body bear 
the marks of a chronic disease of many years 
standing. From results, we must conclude, that 
the causation is of a functional rather than an 
organic origin. That this is not hysterical, lam 
inclined to think, from the fugitive nature of the 
attacks, their constant unvarying character, and 
the lack of distinctive symptoms. The analogy 
between her disease and chorea is more intimate, 
though the latter is not paroxysmal or spasmo- 
dic, but consists rather in an imperfect command 
of the ■will over the muscles, which are ever 
executing movements contrary to its bidding. 
The symptoms presented by this case resemble, 
in a striking manner, those observed in the few in- 
stances of Salaam Convulsions that are recorded ; 
but differ in the fact that this disease has been 
alone seen in children, and has been found to end 
in a lesion of the brain, as shown by the super- 
vention of either epilepsy or idiocy. 
in the manner in which, subsequently, it affected 
the entire body. Hitherto, the spasms were 
moderate in extent, being confined almost wholly 
to the muscles supplied by the portio dura of the 
seventh pair of nerves, excepting, at the more 
severe seizures, when there would be slight tre- 
mors in other parts of her body. At the end of 
the fifth week the convulsions, that had of late 
been very violent in the left side of the face, sud- 
denly becoming general and reached their acme ; 
when a remarkable series of phenomena pre- 
sented themselves,- which I shall attempt to 
describe. 
In the first place, a twitching began at the 
left angle of the mouth, that extended, as it 
became more violent at this point, over the left 
side of the face, neck and upper portion of the 
chest; and then, as these parts were fully con- 
vulsed, the left arm, side and leg in succession 
became affected in the same manner. Beginning 
at the face, the right side was invaded in the 
like order; (the convulsions being unabated in 
the parts already attacked;) when the whole 
body was racked by the most frightful tetanic 
spasms, which distorted the face with a horrid 
ghastly grin and bowed the body in an arc, so 
that the back of her head and her heels alone 
rested on the bed. Remaining in this position for a 
few seconds, during which the skin assumed a 
blue tint from the non-aeration of the blood ; 
suddenly, the muscles became relaxed, a deadly 
palor came over the face, the eyes glared open, 
respiration ceased, the pulse stopped, and also, 
apparently, the action of the heart. Every ap- 
pearance of death was present; yet, in a few 
seconds, there_ could be detected a feeble pulsa- 
tion of the heart, a returning wave of blood in the 
arteries, and a gentle movement of the ribs, 
which increased in power, until, at length, with 
a rekindled vital‘energy, every organ fulfilled its 
office. These convulsions continued for twenty- 
four hours; and recurred precisely, to a second, 
every ten minutes; one the exact counterpart to 
all the others, without the slightest deviation 
either in the time of their continuance, or the 
character of the phenomena presented. The 
paroxysm occupied five minutes, reckoning from 
the first noticeable movement at the angle of the 
mouth to complete relaxation of the muscles, and 
the interval, consequently, covered the same 
space of time. The spasms after continuing for a 
day and night abated gradually in frequency and 
AN ANOMALOUS FORM OP CONVULSIONS. 
Twelve years since I attended Mrs. G., 52 years 
of age, whose constitution, never very robust, had 
been shattered by continuous and excessive over- 
work. Being a woman of great energy and am- 
bition, prudential considerations failed to induce 
her to be more sparing of her health ; particularly 
was this the case for several years preceding, 
when she redoubled her exertions, not only to 
support the family, more or less dependent on 
her, but also to educate her only son—the idol of 
her heart—at college. Eventually, exhausted 
nature gave out, and she was obliged by weakness 
and nervous irritability to take to her bed. For 
the first two weeks she had, in addition to great 
prostration, several convulsive attacks, which 
were thought to be of an hysterical character; 
but gradually they became more frequent and 
assumed a remarkable phase. During the third 
and fourth weeks of her illness, the peculiarities 
in this case became more marked and distinctive; 
and, near the close of the time, the convulsive 
action of the left side of the face presented itself 8 
Here the pain and soreness had now become 
seated, and were the chief subject of complaint. 
On reducing the intestine, as was readily done, 
it was found to protrude again, though the pa- 
tient did not rise from her bed. The truss she 
had been striving to' wear being useless, after 
several days’ delay, a new one was procured, 
which answered its purpose effectually; but still 
her symptoms, instead of improving, gradually 
assumed much greater severity. These, more 
typhoid in character, were attended with a pro- 
fuse perspiration, and a pulse lacking force or 
volume, and gradually rising to 120 beats per 
minute. The bowels became permanently dis- 
tended with gas ; and the tenderness, extending 
from the right iliac region over the lower portion 
of the abdomen, was now most marked above 
the pubic bones, where a hardness and resiliency 
could be felt, as though the hand came in con- 
tact with an elastic incompressible substance. 
This was the enlarged womb, as was more accu- 
rately diagnosticated by an examination through 
the vagina and rectum. 
By the speculum the uterine neck was found 
to be puffy, of a pale color, and the os uteri more 
patulous than natural. 
Such was our patient’s condition during the 
third week of our attendance. 
The treatment consisted internally of anodynes, 
antispasmodics, and laxatives ; and externally of 
fomentations, leeches, and blisters. 
The symptoms mentioned above continued into 
the fourth week, with increasing evidences of 
prostration, and the addition of occasional feel- 
ings of chilliness and trembling, and a constant 
coldness of the extremities. 
The treatment was changed for one tonic and 
stimulating. 
On repeating the speculum examination, a 
small quantity of pus was seen to exude from the 
os tincm; apparently, forced from the uterine 
cavity by the pressure of the instrument. This 
observation was verified on several of the days 
following. The pus increased in quantity for five 
or six days ; then gradually diminished for about 
the same period; and, ultimately, disappeared in 
two weeks time. At first it was thick, yellow 
and laudable ; but near the close, became bloody 
and sanious. Altogether there must have been 
from eight to ten ounces discharged; since, for 
several days, whenever the speculum was intro- 
duced, from four to six drachms of matter oozed 
force ; and then in seven or eight days returned 
to their original character; though they still 
manifested a proneness, as shown by tremors in 
the limbs, to extend from the face to other parts 
of the body. This lady is now living in the full 
enjoyment of her mental faculties ; and has, per- 
fectly, the use of her limbs, and, although an in- 
valid, is able to go around the house, do light 
work, and walk or ride out, a condition of things 
showing conclusively that there is no lesion of 
the nerve-centres; in other words, that her dis- 
ease is functional not organic. Of late years 
the attacks, infrequent and trivial, are confined 
to the left side of the face, and limited to a light 
spasmodic twitching which is apt to occur when- 
ever she is worried, irritated or over-tired. 
My friend, Dr. McClellan, attended this case 
with me in consultation, and was, equally with 
myself, surprised and puzzled at its singular and 
anomalous character. 
AN ABSCESS IN THE MUSCULAR WALLS OF THE UTERUS. 
In April, 1854, I was called to visit Mrs. M. 
an American lady of this city, forty years of age; 
whose catamenial periods had, for several months, 
been irregular in recurrence and variable in 
quantity; a condition due, apparently, to the 
approaching decline of the menstrual function. 
Bor several years she had had, on the right side, 
a femoral hernia; which, originating during one 
of her labors, was poorly retained within the 
abdominal cavity by an ill-fitting truss. The in- 
testine, which had been irreducible by her efforts 
for several days, was sensitive to the touch, and the 
centre of irradiating, lancinating pains. There 
was considerable sympathetic disturbance—loss 
of appetite, tympanitic abdomen, nausea, ner- 
vous irritability, a quickened though soft pulse, 
no active febrile movement, but rather, a prone- 
ness to perspiration with increased heat of the 
surface. There was tenderness over the hernial 
protrusion, which extended to the right iliac re- 
gion ; but there was neither tenderness or hard- 
ness observable in other parts of the abdomen. 
On careful inquiry, no symptoms pointing to the 
uterus as the seat of disease, were discoverable ; 
excepting the fact, that, some two weeks before, 
the patient had wet her feet during the monthly 
flow, which was suddenly checked. Then she 
began to be troubled with flatulence and pain of 
a colicky nature, which seemed to centre around 
and above Poupart’s ligament on the right side. 9 
from the os uteri; and, besides, at other times 
there was a constant dampness on the cloth 
applied to the external parts. As the pus was 
eliminated, the tenseness, distension and tender- 
ness of the abdomen rapidly subsided ; when the 
uterine globe, perfectly defined in its outline, was 
felt, by the hand applied externally, to be nearly 
the size of the closed fist. The state of the uterus 
appeared much as it is after confinement; and its 
subsequent involution was equally rapid and per- 
fect. 
Notwithstanding the relief of the local suffer- 
ing was most complete, the constitutional status 
of our patient became each day more uncertain, 
and eventually highly alarming—hectic, colliqua- 
tive perspiration, a running feeble pulse, ranging 
from 130 to 140 per minute, and a prostration of 
the life-force so profound, as to warrant the most 
serious apprehensions in regard to the ultimate 
result. Nutrients, tonics and stimulants were 
pushed with redoubled assiduity, and though the 
contest seemed doubtful for a time; eventually, 
our efforts were crowned with success. The pa- 
tient, convalescent in ten weeks, regained her 
wonted health in the two following months. The 
uterus returned to its normal condition and there 
were no remaining pelvic disorders to remind her 
of this long and dangerous illness. 
This case, from its extreme rarity, merits a 
careful study. Yery few practitioners, however 
broad their field of observation, have ever met 
with an instance analogous to this; and, though 
solitary cases have been published, most syste- 
matic writers do not, even in name, allude to such 
a disease. Examples of it are to be found de- 
tailed in the works of Mauricean, Yan Swieten, 
La Motte, Ashwell and Scanzoni, but none, more 
remarkable or better defined, than the one just 
related. 
undoubtedly, the steps of the process were identi- 
cal with those that occur in the formation of a 
phlegmonous abscess in any other portion of the 
body. 
This abscess instead of rupturing into the 
peritoneum, rectum of bladder, fortunately dis- 
charged its contents into the uterine cavity; 
whence there was a free exit, that allowed the 
womb to subside and the walls of the abscess to 
coalesce and close. That its location was either 
in the fundus or body of the uterus was made 
out by palpation of the abdomen, and by the 
touch through the vagina and rectum. It did 
not implicate -the neck; this being neither in- 
flamed, tender, congested, or much swollen ; nor 
was the pus formed in the cavity, since the patu- 
lous state of the os forbid its retention in any 
quantity. The body and fundus of the uterus, 
uniformly enlarged as in pregnancy, subsided 
rapidly, in volume on the supervention of suppu- 
ration ; when the patient alone suffered from 
those typhoid symptoms, that always follow the 
discharge of large, deep-seated abscesses. That 
this was the sole lesion was shown by the return 
of the womb to its normal condition, and the lack 
of any remaining pelvic disorders or even painful 
sensations. Probably the peritoneal inflamma- 
tion was slight and localized ; and, scarcely, could 
there have been an affection of the uterine veins, 
since phlegmasia dolens or pyaemia would have 
almost surely followed. 
With the consent of the husband, when the 
appearance of pus indicated the nature of this 
unique case, I availed myself of the counsel of my 
friend Prof. James K. Wood. I was more espe- 
cially anxious to obtain his opinion in regard to 
the pathological changes that had taken place, 
and thus have my conclusions confirmed or dis- 
proved. The examination was gone over with 
great care and circumspection, and resulted in 
establishing to the satisfaction of us both, the 
views advocated above. 
In our patient, (if we may be allowed to inter- 
pret the phenomena presented,) the sudden check 
to the menses caused a congestion of the uterus; 
which taking place at the climacteric period, 
when the function of the organ was declining, and 
the power to resist morbific agencies was less 
potent, resulted in a permanent stasis of blood. 
This continuing several days, though manifesting 
itself only by gradually increasing sympathetic 
disorders, eventually resulted in a circumscribed 
inflammation in the muscular walls of the womb. 
This inflammation went on to suppuration ; and, 
Commentary. 
FRACTURE OF THE FEMUR BY THE MUSCULAR CON- 
TRACTIONS OF THE UTERUS IN A NATURAL LABOR. 
Two years last June, I attended Mrs. 0. in her 
second confinement. I was first called at 
o’clock in the morning, and found her about the 
room ; as yet, only suffering the cutting pains that, 
commencing lightly two hours previously, were 
now rapidly getting stronger and more frequent. 
Thinking there was ample time, I returned home 10 
for my breakfast, and visited her again a few 
minutes after 8 o’clock; at which time, the pains 
■were more active and rapid, tending to those of 
an expulsive character. She was requested to 
lie clown; when, on examination, the os uteri 
being found dilated almost to the extent of the 
circumference of the head, (which presented in 
the first position,) I ruptured the membranes. 
Directly the uterine contractions became strongly 
expulsive, and by two efforts the head was forced 
down so as to distend the periuEeura. A third 
expelling the head was, with scarcely an inter- 
mission, followed by a fourth, which brought the 
child into the world. My left hand guarded the 
periuEeum, and my right, supporting the child, 
received it in the open palm as it was evolved. 
This double pain was powerful and energetic, but 
less so than I have frequently observed; since 
the expelling force was seated chiefly in the uterus, 
and the woman, having nothing to brace her feet 
upon or pull at with her hands, could not most 
actively bring the voluntary muscles into play; 
and besides, as I observed, the rapidity of the 
descent of the head, she was directed to restrain 
her efforts. 
I divided the cord and attended to the 
woman, not suspecting that anything unusual had 
transpired, until the person, who had washed the 
child, asked me to look at its leg, which she 
thought was broken. Great was my surprise, on 
examination, to discover that the left thigh bone, 
at the junction of the upper with the lower two- 
thirds of the shaft, had suffered a complete trans- 
verse fracture, allowing the lower fragment to 
be moved in any direction without the movement 
being communicated to the upper. There was 
the most unequivocal crepitation, when the 
broken ends were rubbed together; and the thigh 
was not swollen nor had callus been formed, 
showing conclusively that the accident had just 
taken place. Carefully placing the child on a 
pillow and adapting the ends of the broken bone, 
I gave directions not to have it disturbed. On 
the next morning the thigh was -swollen, hot, 
and, evidently, from the child’s cries when moved, 
painful. The main difficulty in the treatment 
was the devising an apparatus appropriate for 
so small a subject and so tiny a limb ; which would 
secure union without shortening or other de- 
formity, but still be light, easily worn, and allow 
the child to be handled and dressed. As, in 
very young subjects, even though the fracture is 
complete, the periosteum is not torn across, and 
little more is necessary in a dressing, since 
muscular contractions are not to be overcome, 
than to keep the bone from bending and the foot 
in the right direction, I selected one as light 
and uncomplicated as possible—simply two thin 
pieces of sole leather the length of the thigh, 
which, when moulded to the leg so as to surround 
it, were padded and applied. A very large mass 
of callus, spreading over one half the shaft and 
quadruple the amount seen in older bones, was 
with surprising rapidity formed: indeed, in three 
days crepitation could not be elicited, in seven 
the consolidation was complete, and in fourteen 
the union was firm enough to dispense with 
splints. 
The child has since, on many occasions, been 
under my observation. At present it is barely 
possible to locate the original place of fracture— 
a small prominence on the outer face of the bone 
alone indicating it:—and, in proof that no de- 
formity exists, the child walks without the 
slightest halt in its gait; and, by careful measure- 
ment, no difference in length between the two 
legs can be detected. 
When born the child weighed nearly eight 
pounds, looked hardy, and was perfectly de- 
veloped ; and, to the present time, has been uni- 
formly well; in fact, I may say, has presented a 
perfect type of infantile health. It has been free 
from sickness, unless trivial gastric derangements 
incident to children cutting their teeth, may be 
so considered; and any evidence of a constitu- 
tional taint has not, as yet, showed itself. 
The parents are hale, hearty persons, rarely 
subjects for medication, neither scrofulous or 
syphilitic, nor in any sort suffering through vice, 
poverty or the sins of their progenitors. 
In October last, Mrs. 0. was confined a third 
time. This labor, tedious in the first stage, was 
as rapid, almost, in the second as the previous 
one—there being only seven or eight expulsive 
pains, the three last of which, were very energetic 
and almost continuous, simulating those occa- 
sioned by ergot. 
When we recollect how difficult it is to break 
the young bone; which, as it contains the mini- 
mum of earthy matter, will rather bend, or at 
most have only some of its fibres ruptured; it is 
inconceivable, how a healthy child presenting the 
vertex, and only subjected to the action of the 
uterus for fifteen minutes after the discharge of 11 
the waters, could experience a fracture of the 
thigh. In head or shoulder presentations the 
arms, and in breech or footling cases the legs do, 
in some instances, take a position that would 
favor this accident; and thus, possibly, a limb, 
driven against the bones of the pelvis, might 
bear the brunt of the expelling force. In this 
case the fracture, as the thigh was not the ad- 
nvancing portion of the child, must have take 
place either in the pelvis, the thigh being flexed 
on the abdomen, and then in the birth forcibly 
extended between opposing points of bone; or in 
the body or neck of the uterus by the violence of 
its contractions, the leg lying transversely and 
the knee and buttock impinging on opposite 
points of the uterine walls. As the pelvis was 
very roomy and not misshapen, I am convinced 
that the fracture occurred in the uterus. From 
the history of the case, both that of the parents 
and the subsequent bne of the child, a disease of 
the bones, causing preternatural fragility, can- 
not be presumed; neither did the mother, by 
falls, blows or otherwise, receive any injury 
during gestation; nor was the pelvis small or de- 
formed, or the labor violent and protracted— 
causes from which the fractures in utero that are 
recorded have arisen, with the exception only of 
those occasioned by obstetrical manipulations. 
Here, there, was no call to interfere, and in fact 
barely time to receive the child; which was ex- 
pelled almost solely by the uterus, the woman, 
meanwhile restraining voluntary effort. 
Altogether this case appears to me most re- 
markable, and I have been unable to meet with 
any on record resembling it. 
In a case published by Dr. Vanderveer, in the 
American Journal of Medical Sciences, May, 
1847, a healthy child, born by the natural efforts, 
suffered a complete fracture of one thigh during 
delivery; yet in that, the foot presented, the 
child weighed fourteen pounds and the labor was 
of more than twelve hours continuance. 
In the same Journal, January, 1841, Dr. Low- 
enhardt relates a case where the humerus, 
forced against the ossa pubis, was broken in its 
upper third by the expelling power of the labor 
pains, and the report heard by him standing at 
the time near to, but not assisting the woman. 
In these cases, strictly speaking, the fracture 
occurred without the uterus; and was due to 
vehement pains spending their force on a limb 
that was caught by the bony walls of the 
pelvis. Here the cause and effect can readily be 
comprehended ; but in our case, reflecting on all 
of its attendant conditions, it seems almost too 
extraordinary to admit of belief, that the mus- 
cular contractions of the uterus alone could 
fracture the bone. 
In the treatment of this case, I was fortunate 
enough to have the counsel and assistance of my 
colleague, Prof. Frank H. Hamilton, who saw it 
on the third day, and watched its progress with 
much interest. 
ELONGATION OF THE NECK OF THE UTERUS. 
Twelve months since the following rare case 
fell under my charge. 
A lady, married but never pregnant, who re- 
cently moved to this city, had been troubled for 
a long period with a train of symptoms, which, 
of a slight nature at first, had, gradually during 
the last five years, become so severe, that fre- 
quently she was confined to her bed with the 
most intense suffering. She was of English birth, 
under the ordinary size, and, until her marriage, 
enjoyed good health, which at the present time, 
to a casual observer, would not have appeared 
much impaired ; as her complexion was florid 
and her person plump and well developed. Yet 
for a long time, almost constantly, she had been 
under medical treatment for a list of liver, 
stomach and kidney disorders, which, arising as 
was thought, primarily, from marsh miasm, 
had settled, finally, into chronic hepatic and 
urinary derangements. 
The medicines administered in accordance with 
this idea failed to afford any but temporary 
relief; yet, notwithstanding, an examination other 
than a general one, was never instituted for the 
discovery of the hidden secret of her many com- 
plaints, although her sensations plainly indicated 
the uterus as the organ where they originated. 
At all times she had the following symptoms: 
a sense of forcing and pressure downward in the 
pelvis, pain and a feeling of dragging, extending 
from the back over the hips to the thighs, tender- 
ness in the hypogastric and iliac regions, leu- 
corrhoea, painful and difficult micturition; in a 
word, all those symptoms, in a marked degree, 
which attend uterine disease, more especially, 
procidentia uteri. After walking or any exer- 
tion, unless of the gentlest nature, the above 
symptoms were always aggravated ; if not in- 
creased to a severe attack, which we will now 
describe. 12 
Once a month, in connection with her menses, 
either during, just before or after the flow, she 
would be seized with agonizing pains of a 
paroxysmal and expulsive character, that were 
attended with vomiting, neuralgia of the head, 
excessive irritability and hysterical spasms: an 
array of symptoms observed in the worst forms 
of dysmenorrhoea. To these, however, were 
added others not peculiar to uterine disease; 
dysuria, a scanty secretion of urine, loaded with 
mucus and depositing lithic acid on standing, 
pain down the course of the ureters, and a tender 
tympanitic state of the abdomen ; which seemed 
to point to urinary calculi as the source of her 
sufferings. 
I examined the patient at two periods; one 
when she experienced the greatest relief and 
felt comparatively well, the other during the 
height of an attack. 
The first examination disclosed the following 
condition of the pelvic organs ; the introitus 
vulvse small and contracting spasmodically on 
touch ; the uterus slightly larger than natural and 
prolapsed into the excavation, and the uterine 
neck elongated by an out-growth of about three 
inches in length, of its normal tissue apparently, 
though it was less firm and dense, which reached 
to the perinseum and encroached on the urethra. 
The uterus, being very movable, was readily ele- 
vated to its natural position; by which manipula- 
tion the feeling of dragging, tenesmus and bearing 
down, that constantly annoyed the patient was 
relieved, and I was enabled more accurately to 
observe the soft, flaccid condition of the hyper- 
trophied neck. 
On introducing a small speculum, as was done 
with some difficulty, this growth was identified as 
an elongated cervix uteri by the opening at its 
most dependent portion, that readily admitted 
the sound. This portion presented a natural ap- 
pearance, excepting a flattening at its extremity, 
which previously was detected by the finger, as 
though it had been pressed for a long time 
against a flat, resisting surface. 
The second examination made it evident that 
in addition to her symptoms at ordinary times, 
she, during an attack, had expulsive throes like 
those in labor, or more precisely, like those oc- 
casioned by a polypus of equal size distending 
the pelvis and pressing on the perinseum. The 
body of the uterus was not more than two inches 
within the external parts ; and its neck, doubled 
on itself, rested with its extremity on the peri- 
nseum, near the fourchette. The mass was 
forced down, so powerfully and persistently, as 
fill completely the outlet of the pelvis; and, 
had it not been for the spasmodic contractility of 
the sphincter vaginae, the elongated neck would 
have appeared externally. It was now very 
difficult and painful to elevate ; the uterus ; and 
when this was done, immediately, by an expulsive 
pain, it was forced down again. 
The husband stated to me that for more than two 
years he had been circumscribed within the limits 
of Platonic love ; and that, from the closure of 
the passage, coitus was impracticable. 
Thinking, that were the uterus permanently 
supported on a higher level, the patient might 
possibly be freed in a measure from her annoying 
symptoms, I introduced a globe pessary on three 
different occasions, when she was in the least 
suffering ; yet, notwithstanding, I used a small 
instrument and varied it each time, it failed to be 
retained, and in an hour or two, came away with 
expulsive pains. This form of pessary disap- 
pointing me, it was not thought worth while 
to resort to others: since, evidently, these pains 
would be equally excited by any foreign body, 
whatever its shape, that was placed in the 
vagina. The stem pessary, it is barely possible, 
might, from its not distending the vagina have 
answered the purpose, but we did not wish to in- 
cur the hazard of uterine inflammation which so 
frqquently follows its use; and, therefore pro- 
posed the excision of the neck of the uterus as 
the only means at our disposal for the relief of 
the patient. As in duty bound, the nature and 
danger of the operation, with what it might ac- 
complish, was properly represented, so that a 
choice, knowingly, could be made between present 
ill health and the promise of restoration. The 
lady, however, concluded yet for a time to bear 
with her sufferings rather than to submit to the 
knife. 
Latterly, nothing has been attempted other 
than medicinal means. With her, camphor has 
a marked effect in the paroxysms, both to relieve 
the constitutional symptoms and also the local 
ones, pain, tenesmus and forcing down. In 
dysmenorrhoea, threatened abortion and for false 
labor pains or those following delivery I have 
found the camphor very efficacious, ranking 
next to opium and even in some instances suc- 
ceeding when the latter failed to give relief. A SECRETION OF MILK AND VULVAR HEMORRHAGE 
IN NEW-BORN INFANTS. 
child. This sympathy is not only potent in 
moulding the foetal organization in utero, but 
continues unmistakably after birth. 
More than this, we have ample evidence that 
the whole human family is bound together by a 
sympathetic chain, and that a power—hidden 
and mysterious—goes forth from person to per- 
son, which is manifested in a sensible way when 
one mind brings another under the sway of its 
will as is shown by mesmerism in its different 
phases. 
By a law of nature, a bodily and mental union 
binds together the human race; but, still more 
intimately, the mother and the foetus in utero. 
This union is not completely severed at birth ; 
since the swellingof the breasts and the secretion 
of milk in the mother are often attended by a 
swelling of the breasts and a secretion of milk in 
the child, and sometimes the lochial discharge of 
the mother by a lochial discharge from the genitals 
of female infants. 
In several cases, during the ten days following 
birth, I have observed the infant’s breasts to be- 
come hard and uniformly enlarged, from which a 
whitish, watery fluid could occasionally be 
pressed. In three or four the breasts became 
caked, precisely as we observe in the adult 
female, and in one, the irritation resulting in in- 
flammation and suppuration, it was lanced, when 
at least three ounces of pus were discharged. 
To disperse the engorgement, squeezing the 
breasts to remove the milk or the use of stimu- 
lating applications should be avoided; and only 
soothing, emollient lotions employed, as for ex- 
ample, flax-seed poultices, stupes of tepid water, 
the simple camphor linament, etc,, etc. 
The two following cases of menstruation in the 
new-born infant, one of which, by the politeness of 
Dr. Gilfillan, I had the opportunity of seeing, 
open a wide field for curious speculation. 
We are too prone to recognize none but crude, 
material agencies ; and, having proven, that the 
foetus has neither nervous or vascular connec- 
tions with the mother, we assume that no in- 
fluence by other channels can pass from one to 
the other. All cases, of which there are many, 
showing that certain results are produced in the 
development of the conception, through the 
mother’s mind or imagination, are ignored or 
treated with scientific contempt, as if unworthy 
of the slightest consideration. In other words, 
being unable to explain the facts, we shut our 
eyes to their existence ; a procedure as sensible 
as it would be to deny the influence of sunlight 
in giving a green color to the leaves of plants, 
because forsooth, it is past comprehension; or 
to question the influence of the many imponder- 
able forces, inscrutable and beyond our ken, that 
conspire to our pleasure, good being and health, 
or produce our discomfort, pain and death. 
Granting that deviations in the development of 
the foetus are unaccounted for satisfactorily, by 
attributing them to impressions made on the 
mother, still, it should be held in mind, that we 
are as little able to explain why the child, as it 
grows up, partakes of the bodily and mental 
peculiarities of its parents. In truth, the expo- 
sitions, given for vital phenomena, can rarely go 
beyond the bare statement of the conditions and 
laws by which they are regulated and usually the 
modus operand! is inexplicable. For example, 
the laws of endosmosis are well understood, yet 
no one has shown how two currents of fluid pass 
at the same time in opposite directions through 
dead animal membranes, much less how these 
laws in living structures are modified or set 
aside. 
In the foetus, whose relations with its mother 
is so dependent and intimate—the offices of its 
lungs and stomach being supplied by her blood— 
oxygen and nutriment transuding from her veins 
to those of the child—we are in the dark as to 
the mode by which an influence passes from one 
to the other, and we know, simply, the fact, that 
a bond of union, (which from the want of a better 
term we will call sympathy) unites mother and 
M. Gubler has observed the breasts of 1200 
new-born infants, and finds in both sexes that a 
swelling of the breasts and a secretion of milk 
takes place in the majority of cases. Indeed, at 
his suggestion, we have an analysis of the infant 
breast milk by M. Quevenne, 
Milk 
Woman. 
Infant. 
Ass. 
Butter, . 
2.60 
1.40 
1.40 
Casein, 
3.90 
2.80 
1.70 
Sugar and 
extractive 
matter, 
4.90 
6.40 
6.40 
Water, 
88.60 
89.40 
90.50 
I therefore come to the conclusion, that the 
new-born infant, by sympathy with the mother, 14 
or by some unknown relationship, has often, kike 
her, a secretion of milk in the breasts; and that, 
by strict logical induction, we are warranted in 
presuming the blood discharged from the vagina 
in such cases to be an analogue of the lochia. 
hours. The evening of its birth it vomited very 
freely and became so blue in the face as to 
alarm its parents. 
April 25th, 1862, six days after birth, the 
mother asked me to examine the child, as her 
garment was stained with blood coming from the 
genitals. The mother stated, that for four days 
after birth there was a whitish discharge, but 
yesterday it changed to blood and came pretty 
freely. The napkin was stained with blood the 
color of port wine. On separating the labia and 
nymphm, a small elongated clot of blood was 
visible, and was removed, when fluid blood 
trickled slowly from above. In the afternoon, 
Dr. Chapman saw the patient with me, and ex- 
amined her very carefully. There was no 
abrasion or source of hemorrhage in the vulva, 
a small coagulum of blood lay in the vagina, and 
the blood was coming from some point out of 
sight. The mother was told to bathe it with cold 
water. It stopped next day and has never re- 
turned. On the 25th, upwards of giij. of blood 
was lost. Both mother and child were and are 
perfectly healthy, and free from any constitu- 
tional taint. 
A hemorrhage of this character in new-born 
infants is singular, and can scarcely be considered 
menstrual in character. I have not seen any 
such cases mentioned by medical writers, and 
from my limited experience of it, I can say little 
to throw light on its causation. In a few new- 
born children, both male and female, milk can be 
squeezed from the mammary glands. In some 
instances, abscess in the gland is observed in the 
first two weeks. These facts show that the 
generative organs are sometimes in a congested 
or irritable state at birth, and perhaps where the 
uterus or its appendages are congested, a little 
hemorrhage takes place from its delicate mucous 
membrane. The origin of the hemorrhage is 
similar to that of the menstrual flow, but the re- 
mote physiological cause must be different. 
Since meeting the first case, I have watched 
carefully for others, but so far I have only found 
a second. 
HEMORRHAGE FROM THE GENITAL ORGANS OP 
FEMALE INFANTS, 
I am induced by Prof. Chapman to give a 
short account of two cases, interesting, I believe, 
from their rarity, and somewhat singular in a 
physiological view. In both, a flow of blood 
resembling the menstrual flow took place within 
a week from birth. 
Case I. Mrs. 0., was delivered of a well- 
formed female child at full time, December 25th, 
1860. She made a good recovery and nothing 
unusual occurred until January Ist, 1861, when 
I was requested to look at the baby, as blood 
came from the private parts and the mother was 
anxious about it. 
On examination, I found the diapers stained 
very freely with dark-colored blood. The genital 
organs seemed healthy,—dark venous blood was 
visible at the lower part of the vagina, and on 
wiping it away, it was slowly renewed, coming 
from a point higher up the canal. There was no 
visible breach of continuity in the mucous mem- 
brane of the vulva. I examined it very carefully 
for this purpose, and separated the lower part of 
the vagina as well as I could, but no abrasion was 
perceptible. 
I advised a weak solution of acetate of lead to 
be used as a lotion, not so much for its curative 
effect, as to satisfy the mother. The discharge 
continued four days, and gradually disappeared 
on the 4th January. The child did not seem 
weakened by the loss, although it exceeded 
giij. in twenty-four hours. 
The mother had secondary syphilis at this time, 
but the child presented no indications of it then. 
March 18th. The child has vesicular patches 
of a syphilitic character. It was put under treat- 
ment with Hydrarg. 0. Greta, and finally got well, 
It is at this date hearty and well. The hemorrhage 
has never returned since. 
Case 11. Mrs. 8., a primipara, was delivered 
of a female child, after a natural labor of twelve 
William Gilfillan, 
Surgeon to the Long Island College Hospital. 
January 19, 1863. 15 
HYDROCEPHALUS CHEONICUS. 
following evening. No persuasion conld induce r 
the parents to consent to an autopsy. 
My colleague, Dr. Gilfillan saw this case during 
the height of the dropsical distension of the head, 
and when after death the fluid had disappeared. 
PROCIDENTIA UTERI DURING GESTATION* 
Mrs. W., healthy, spare hahit, and the mother 
of three children, came under my observation 
during her second confinement. My attention had 
been called to nothing unusual in her case. I saw 
Mrs. W. on the 19th November, 1849 ; she re- 
marked that her womb had been down for three 
weeks, with a constant bloody discharge, rather 
freer than the menses, but natural in appearance. 
For three weeks she had been constantly on her 
feet attending to her household affairs. During the 
three weeks she had made many efforts to reduce 
the womb, which, from its size and tenderness, 
were ineffectual. I directed her to keep her bed 
till the next morning, and in the meantime foment 
the womb constantly, when I would call again and 
reduce it. 
Nov. 20th.—On examination, I found the womb 
of the size of the two closed fists, completely ex 
ternal to the body. My thumb and fingers could 
meet above its fundus, external to the vulva, 
having only the inverted vaginal walls and liga- 
ments of the womb between them. When she 
was erect, the womb must have extended nearly 
to her knees. At the time, I supposed the en- 
largement of the womb arose from its strangulation 
and congestion. It is proper to remark, that Mrs. 
W. said she had been subject, since her first child 
was born, to an almost constant procidentia when 
she was on her feet, which she never before had 
found trouble in reducing. I effected the reduc- 
tion without xpuch difficulty; applied a compress 
over the vulva, with a T bandage, and directed her 
to get up after two or three hours. 
Nov, 21st.—Immediately on getting out of bed, 
the procidentia occurred again. I directed her to 
lie down, and then found the womb more irritable 
and larger than before. I reduced it immediately, 
but with considerable difficulty and the exertion 
of some force. She was directed to keep the re- 
cumbent posture and use astringent injections ; a 
putrid discharge followed, and continued five days. 
On the 4th of December she felt life, fifteen days 
from the first reduction. After this time she was 
allowed to get up, and I discontinued my visits 
after the Bth. 
On the 15th of March I was called to Mrs. W. 
A year ago the last fall I was called to see an 
infant a week old, which, the day previous, was 
seized with convulsions. The cause could not be 
detected; and, as the child was well developed and 
every function seemed to be naturally performed, 
it was presumed to be an obscure state of irrita- 
bility of the nerve centres ; which, in so young a 
patient, would in all probability eventuate in 
death. The convulsions of a light and transitory 
character, only continuing a few moments, re- 
curred for many weeks, occasionally skipping a 
few days ; though usually, they numbered from 
five to twenty in the twenty-four hours. After 
some little trial of the usual remedies, I told the 
parents the case was hopeless ; and that it was not 
worth our while to trouble the child with drugs 
that could do no good. Contrary to our expecta- 
tions, the child continued to live, notwithstanding, 
there was no amelioration in its symptoms ; and to 
increase in size and plumpness, though its de- 
velopment was tardy and imperfect. About the 
second month a divergence of the eyes was very 
noticeable ; at four mouths the head began to en- 
large, when the convulsions became less frequent, 
and eventually ceased altogether; at five months 
the fontanels were large, the cranial bones widely 
separated at their sutures, at which time the head 
must have contained nearly a pint of fluid. 
After the period above mentioned, not having 
seen the child for ten days, I was sent for again. 
Great was my astonishment at finding the head 
completely emptied of the dropsical effusion; the 
bones loose and movable, and the fontanels and 
spaces, when the sutures were separated, cupped 
downwards by the pressure of the atmosphere. 
The mother, and another woman living in the 
same house, stated, that for the three previous 
days, clear drops of water trickled down from the 
ears and nose, but more especially from the last 
named; and that at the same time, the head 
began to lessen in size, the soft parts to fall in and 
the bones to settle together. 
Now also the convulsions returned. 
The fluid had ceased to ooze away, when I saw 
the patient, and none, as I satisfied myself, re- 
mained within the skull. I Died, with the hands, 
what would be the effect of restoring to the brain- 
mass, as far as possible, an equable pressure ; 
which nature, so to speak, negligently omitted to 
do in this remarkable freak of her surgery; but 
as this procedure excited continuous convulsions, 
the idea that I entertained of applying adhesive 
strops was not carried out. The child died the 
* Republished from New York Journal of Med., ISSI, and 
Kanklng’s Abstract, 18.jo. 16 
again. She said that she had continued feeling- 
life stronger and stronger every day since I had 
last seen her ; that the womb had been down many 
times since my last visit, but that she had been 
able to put it baek ; that now it was down further 
and of greater size than ever before, and that she 
could not reduce it. Besides, she had labor-pains 
that recurred every ten minutes. I found the 
fundus uteri as high as the umbilicus ; the neck 
of the womb, external to the genital fissure, some- 
thing larger than the two closed fists. Through 
the os uteri I could feel the child’s head resting 
on the rami of the ischia and ossa pubis. As I 
failed to reduce the uterus while she lay in bed, I 
directed her to turn on her face, resting on her 
knees and shoulders, in which position I easily 
succeeded. On examination, I felt the os uteri 
dilated to the extent of a circle two inches in dia- 
meter. The pains gradually subsided, and in two 
hours time the os uteri had contracted to the size 
of half a dollar. 
active and powerful after the rupture of the mem- 
branes, that took place thirty-six hours previously, 
became eventually less regular and energetic until 
they subsided almost completely; and now the 
patient worn out by ineffectual efforts and long- 
continued sufferings, was reduced to an extreme 
state of exhaustion, as was evident, not only from 
the cessation of uterine activity, but also from the 
constant retching and vomiting, the restlessness 
and jactitation, the dark, suffused countenance 
and rapid, running and flickering pulse. 
On examination the right shoulder and arm of 
the child were found in the excavation, its back 
toward the pubes, and its head to the left side of 
the mother, resting above the rim of the superior 
strait on the ramus of the pubic bone. The shoul- 
der was not crushed down as low in the pelvis, as 
usually is the case in such a presentation left to 
itself, but drawn closely to the left side ; and the 
body extending toward the right sacro-iliac syn- 
chondrosis and doubled forward on itself, had been 
forced below the superior strait, allowing the scap- 
ula, spine and back portion of the ribs to be 
reached by the finger. In other words the child 
seemed to lie very nearly in the oblique diameter 
of the upper strait with the shoulder and back 
part of the chest below the linea ileo-pectinea. 
The os uteri could not be felt by the finger. 
To confirm my diagnosis and make surety 
doubly sure, I now pulled down the arm and thus 
made myself certain of the presenting part by 
ocular inspection. 
Not supposing that Nature would come to my 
aid, I left the house to obtain an assistant and also 
to procure my instruments. On my return in half 
an hour’s time, I discovered that in the meanwhile, 
the pains had become expulsive and of considera- 
ble force ; and by an examination, that the right 
buttock was distending the perinaeum as in an or- 
dinary breech presentation and that the arm had 
receded within the pelvis. Without any interfer- 
ence on my part, other than a gentle traction with 
my finger in the groin, the child, which was dead, 
was born in a few minutes. The process was ex- 
tremely rapid and no unusual distention of the 
perinamm took place. 
After a short respite, a second child, presenting 
the breech, was born dead. The woman by her 
reckoning, and from the maturity of the children, 
had attained the full period of gestation. I regret 
that from neglect I am unable to state the weight 
of the children accurately; though in both, I should 
think, it was between and pounds. 
Had I not witnessed the change of position 
On the 29th of March she was taken in labor, 
and delivered of a strong, vigorous female child, 
weighing six pounds. She must have been at her 
full term, from the development of the child’s 
head; the posterior fontanel was closed, and the 
anterior was no more open than usual. No proci- 
dentia occurred during the labor, but the womb 
rested low in the pelvis. Mrs. W. said that the 
womb had come down every two or three days 
since the reduction in November, and also in 
March, but that, by lying clown, she could reduce 
it. Probably after the reduction in November, the 
procidentia was only partial. During her whole 
gestation the child’s head undoubtedly rested on 
the perinseum, as she remarked that it always 
seemed to her that she sat on the child. 
She was delivered 130 days after the reduction 
in November, consequently (allowing 280 days for 
the tei’m of gestation) she was at that time ad- 
vanced 150 days, or 21 weeks and three days, or 
about five months. At this time, it is to be recol- 
lected, when she was five months advanced in 
pregnancy, the womb had been completely exter- 
nal to her body, hanging nearly to her knees for 
the space of three weeks ; and during this time she 
continued about her house every day, suffering 
nothing more than the inconveniences of dragging 
pains, the discharge, and the obstruction to walk- 
ing, from the bulk of the womb and its tenderness. 
SPONTANEOUS EVOLUTION, (PELVIC.) 
In the winter of 1851, I was called to a young 
woman in her first labor, who, for more than two 
days had had a midwife in attendance. Her pains, 17 
effected in this case by the natural resources, the 
possibility of spontaneous evolution at the full 
term of gestation would have always been to my 
mind problematical. It is certain that under the 
most favorable conditions, when the pelvis is roomy 
and the child small, this result is not to be expected 
or waited for, but that it can and has happened 
many times, as recorded by writers, I must now be- 
lieve. 
Two theories have been advanced in explana- 
tion of the mechanism by which spontaneous evo- 
lution takes place; the older, that of Denman, 
who was the first to describe and illustrate the 
process, was that the shoulder being driven against 
the unyielding sides of the pelvis, gradually in the 
periods of uterine relaxation, slid upward into the 
cavity of the uterus, taking the place of the breech, 
which in an equal degree slipped down into the 
excavation. In other words he supposed the child 
to revolve as on an axis, the buttock and shoulder 
eventually changing places ; when the labor was 
completed in the same manner and with as little 
delay as in an ordinary breech presentation. 
This theory of Denman’s was universally ac- 
cepted by the profession, until it was called into 
question by Dr. Douglass in 1811, who proved, as 
it was thought, satisfactorily, that the explanation, 
offered by this author of the phenomenon, was 
incorrect, and that the presenting part could not 
return into the womb, when this was condensed and 
powerfully contracted, and thus allow the breech 
to glide into the excavation ; but that the shoulder 
after many and powerful pains became fixed under 
the pubic arch, by which means the acromion pro- 
cess was thrust into the vulva and the neck against 
the inner face of the ossa pubis, when, through the 
slight additional space thus given, the body of the 
shild revolved on this fixed point as a fulcrum and 
was born by its coming down the pelvis doubled 
on itself and passing the vulva en masse without 
any change in the position of the shoulder, thus 
necessitating a frightful distention of the perinseum. 
In other words the shoulder is partly born, when 
becoming arrested by the neck impinging on the 
pubic bones, the foetus revolves around this fixed 
point, and at the birth its entire body comes into 
the world at the same time. 
It is not for me to deny that the process delinea- 
ted by Dr. Douglass can take place, though I must 
confess that my doubts amount to an unbelief in 
this explanation of the act of evolution at the full 
period of gestation. It certainly seems impossible 
and I am certain that the evolution in the case re- 
lated above was not effected in this manner. The 
woman was exhausted, almost in a moribund con- 
dition, the real pains of labor had died away, leaving 
only unequal irregular spasmodic contractions in 
their place. The shoulder was not under the pubic 
arch, and when, on my return to the house, the 
pains had recommenced, the shoulder was not to be 
felt, the arm was drawn up and the breech passed 
the perinseum, rapidly and with the greatest ease. 
In fact if at this stage I, for the first time, had seen 
the case I should never have suspected that it was 
other than a breech presentation. 
It appears to me, that, as the child’s neck rested 
on the ramus of the os pubis and its head extended 
into and was bent toward the abdomen by the neck 
of the womb, and as the side and back of the chest 
projected below and extended across the superior 
strait to the sacro-iliac symphysis, and as the but- 
tocks were embraced by the opposite point of the 
neck; the irregular, spasmodic and cycumgyrating 
contractions of the uterus, but more especially of 
its neck, during the respite from true labor pains, 
changed the position of the child—elevating the 
head and shoulders and equally depressing the 
breech into the pelvis—when the pains were re- 
newed. Judging from my observations in this 
case, I should' say that spontaneous evolution, 
whether pelvic or cephalic, could occur in no other 
way, and that it must take place during the ab- 
sence of the regular labor pains, by the unequal 
muscular action of the uterus or its neck shifting 
the position of the child.