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 1653 Ec • Main Slreel 
 
 Rochester, New Ycrk 14609 USA 
 
 (716) 482 -0300- Phone 
 
 (7ie) 288 - 018" - i^n. 
 
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 STA.TISTTCS 
 
 OF THE 
 
 UNIVERSITY I.YJNa-IN HOSPITAL, 
 
 7 
 
 I^rONTRKAL. 
 
 
 AKCIIIJ'.ALI) HALL, M.I)., K., L.U.C.S.E. 
 
 iTivsiriAN-ArcoL-ciEn; TO Tin; sAMi;; nioi k.<,-,o.: of miduifeuv /m, tii:: m.sea^f. 
 
 "!■ WOMK.V ANN CIIILDHD.V, rXIVEnSITV ni- .vi;iI,L fOI.I.KdK; PIIESIDKVT nr 
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 iO\<ri.TIN'; I'UVSICIAN .MO.VmKAL liEXKRAr. rio=riTAI. : 
 ETC, ETC , ETC. 
 
 (From ili( Briliah Amrnani Jiwnidl.) 
 
 Jttoutic;il : 
 PTITXTRD V>Y .TOITX LOYELL, ST. XTCTTOLAS STKKKT. 
 
 1860. 
 
 
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 ART, YIU.— Statistics of the University Lying-in Hospital, Montreal. By 
 Archibald Hall, M.D., PhyHieian Accouclieur to the same ; Professor 
 of Midwifery, &c. University of McGill College ; President of the College 
 of Physicians and Surgeons of Lower Canada ; Honorary Fellow of the Ob- 
 stetrical Society of London, &c., &c. 
 
 The importance of Statistics is now acknowledged in the different Medical 
 Sciences, and they have been happily brought to bear upon the settlement of 
 many disputed points. But in none is their influence of such moment as in 
 Midwifery, as they have established with a degree of precision which cannot bo 
 questioned, many highly important principles, if they can be so called, which 
 lie at the foundation of its science and practice, and it is here, far more than in 
 Medicine or Surgery, that their great influence must be chiefly confessed. 
 Nature always operates by laws which we are enabled to appreciate only by this 
 means, while at the same time, we become enabled by the same means to estimate 
 the slightest deviation from them. The greater the amount of statistical informa- 
 tion, therefore, which can be brought to bear upon certain given points, the 
 more surely will these become established as principles or laws, and it is with 
 the view of contributing to the mass of information which we already possess 
 OB many interesting subjects connected with midwifery, that I throw the follow- 
 ing results into the common fund ; but, before entering directly upon the more 
 immediate subject of this paper, it may be well to premise a few remarks on the 
 history of the Institution, whose operation has furnished them, by way of shew- 
 ing its advantages as a means of studying obstetrics practically. 
 
 The first Lying in-Hospital established in Montreal, was founded by the lat« 
 Dr. MacNider, in the year 1841, and went into very successful operation. In 
 consequence, however, of a refusal to allow the students of the University access 
 to it on account of the practical advantages which it was thought capable of 
 affording, (Dr. MacNider at that time being a lecturer on midwifery in tho 
 Montreal School of Medicine,) it was deemed proper about a couple of years 
 afterwards by the Professors in the University of McGill College, ; found one 
 in couuectiou with the University, and to place its professional control in the 
 hands of the Professor of Midwifery, intimately associating it with the chair. 
 
2 
 
 > 
 
 Tho practical nJvantnfjcs thus accruing to the students nt tho Univerflity by 
 this arran-^oment arc obvious. Shortly after tho decease of Dr. MacNider, an 
 event whieii took phico in tho year 1840, lii.s Hospital was closed and has not 
 since been re-opened. 
 
 At the present moment there arc two Lying-in-IIospitals in Montreal. One 
 is tlio Ilopital do St. lVlat,'io, a lloman Catholic Institution, admitting 
 Protestants, however. It is under the eeonomic manaf,'ement of the Sisters of 
 St. Pehifrie, and the professional char<j;e of Dr. Trudelle, the present Lecturer on 
 Midwifery in the Montreal School of Medicine. It admits a considerable 
 number of patient - during the year, and the students of that school have, as I 
 have understood, access to it. Tho other is the University Lyin--in-IIospital, 
 which was opened in November, 1843, as well for charitable purposes, as for 
 the instruction of the students in the Faculty of Medicine of JlcOiil C<.lle,i,'e in 
 practical midwifery, an object which it has carried out as successfully as its 
 opportunities permitted. For the first ten years of its existence, the Hospital 
 was under the able superintendence of the late much lamented Dr. MeCulloch, 
 then the Professor of Midwifery in tho University, and since that Kcntlennui's 
 decease by Asiatic Cholera during the last visitation of that epidemic in 1854, 
 it has been under the charge of the present Professor of that branch ; tho other 
 members of the Medical Faculty of the University, liaving always constituted a 
 Board of consulting Physicians. It is supported partly by voluntary subscription, 
 and partly by an annual Legislative grant, increased during tho last two or three 
 years to £75 per annum. Tho amount received from the former source is very 
 limited, but in consequence of strictness in collecting from pay patients and the ex- 
 tremely prudent economic management of its matron and resident midwife, Mrs, 
 Hope, who is thoroughly instructed in midwifery, and has received the license of 
 the College of Physicians and Surgeons, the Hospital has not only a sufficiency to 
 meet its annual expenditure, but has been enabled to li(iuidate a considerable 
 debt, which oppressed it a few years ago. A kind benefactress, the late Mrs. 
 Maria A. Monk, becjueathed to it at her decease in 1853, the generous amount 
 of £2G2 10s., which was immediately invested in Bank stock, and having been 
 increased from time to time as circumstances allowed, the Hospital has now, to its 
 credit, the sum of £300, which is reserved as a fhnd for the erection of a suitable 
 building at a future day. The premises which it now occupies are by no means 
 adapted to the purposes to which they are applied, but no better can at present 
 be obtained. The Ho.spital is, however, conveniently situated, being close to 
 the lecture rooms and the Montreal General Hospital, and of easy access to the 
 students. 
 
 A minute record is kept of every case. As soon as a patient enters, the fol- 
 lowing particulars are noted in regard to her— the date of admission,— her name, 
 —her age— and the country of her birth ; and, when the accouchement has been 
 completed, the following additional details are recorded,— the kind of labour— 
 the nature of the presenting part— the duration of the labour— the time before 
 the delivery at which the membranes ruptured— the sex of the infant,— its 
 kngthand its weight,— the weight of the Placenta,— the length of the umbilical 
 c«id, the number of days since the last catamenial period— the condition in 
 
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 .1 
 
 . i 
 
 
8 
 
 >. . 
 
 v:i 
 
 <•. 
 
 r 
 
 * 
 
 .1 
 
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 which the child wns born, whether living', still, or dond, — whcthor the cnsc in a 
 first, second or tliinl, &c. j,'c,Htiition, and liistly tiio date of her dischiir;.'o from 
 the Hospital, and after a catoj^orical reply to all these ((uestions, any peculiari- 
 ties in the labour are finally detailed under an appropriate headini;. All these 
 particulars are entered by the student in attemlance on the case, immediately 
 after the termination of the aceouelienient, so that in time a truly valuable amount 
 of statistical information will be obtainable. Tlio Hospital lias now been in 
 operation sixteen years, audit is the results which during that time have accu- 
 mulated, which furnish the f;roundwork of this paper.* 
 
 It appears tiiat duriiif^ this period of time I'.KiH women have been admitted as 
 patients, beinj; an annual averaftc of about 1213, Of these five were cases of 
 Abortion, which reiiuire to be deducted from our calculations. It is necessary 
 to remark that the total number f^iven includes a list of 747 cases of which tt 
 very minute portion only of their details has been preserved, viz. : their admis- 
 sion and coiifiiienicnt. I will only use these in a jreneral way. Every endea- 
 vour has been made to discover where these records are, but without avail. It 
 is exceedingly to be regretted that any portion of them whatever has been lost. 
 
 The suflBciently large number of 1210, however, yet remain whose details 
 have been preserved in their comparative cntireness. It must be further 
 observed, that it is sometimes impossible to fill up answers to all the (juestions ; 
 and I may exemplify this remark by the well known difiiculty in determining 
 the number of days intervening between the cessation of the catanienia and the 
 commencement of labour, but in all cases in which the results have been obtained 
 from numbers less than the total, the precise number will be stated. 
 
 I propo.se to enumerate at first general details ; and I will reserve to the con- 
 clusion of the paper, the narrative of such peculiarities in the labours as have been 
 specially noticed in the records. 
 
 Of the 19G0 women admitted, besides deducting the five cases of abortion 
 already noticed, we have further to add to this latter number, 14, who either 
 left the Hospital before delivery or were expelled for bad conduct. These 
 deductions reduce the total number to 1949. 
 
 Of the 1949 patients 17 have died, the causes of the deaths having been the fol- 
 lowing : — five from puerperal fever ; six from peritonitie and metritic affections; 
 one from epilepsy complicating the labd':, uid ending in cerebral congestion ; 
 and five from puerperal convulsions. This proportion yields a ratio of mortality 
 in the cases, of 1 to 114.G labours, thus exhibiting a highly favourable ratio. 
 
 Of this number there arc only 1208 entries in the register, which can be ren- 
 dered tributary to the purposes of this paper, the record containing nothing 
 
 •In the British American Journal of February, 184Y, the late Dr. McCulloch contri- 
 buted an interesting paper on the statistics of the Hospital based upon 3S4 cases, which 
 had up to that period of time been admitted. Tliese cases which furnished the ground 
 worlc of his deductions are among the 1\1, whose details are now all lost except there- 
 cord of their admission and confinement. I will therefore avail myself of his labours when- 
 ever I fird them suiting my purpose. 
 
 More lately. Dr. Fenwick, with my permission, has given, in the Medical Chronicle 
 for September, 1857, the particulars of 1009 accouchements. 
 
^> 
 
 > 
 
 whatever, of the lalanoo of 747, with few oxcoptionH, except their name, date of 
 entry, conflnc.uent and religion. It appcarn, however, that the 120H ptve birth 
 to 122:} chiLInn, ofwlH.,,, (W7 were hc^M. and f,5C were Ki.Is, and adding tho 
 HtatLstaN of Dr. MeCuiloeh, of the im which he reported, wo have tho follow- 
 inK nunibcrH, 845 boyn and 7;J2 nirls. 
 
 Tho BKi-Hof i:i01 are ^ivun, and after classification they appear as follow •— 
 
 from 30 to M 
 
 .85 
 
 from ,'{5 to 40 43 
 
 from 40 to 4£i 3 
 
 from 45 to 50 1 
 
 recorded by Dr. McCiilh.cli in his 
 
 1 5 ycurH of n-ic and under, 1 
 
 from 15 to 20 2.'{5 
 
 from 20 to 25 B8G 
 
 from 25 to .'tO 347 
 
 Tho a^'e of the youiif,'e,st ndmittod ?■ 
 paper. It wa.s 14 year« „ml 7 months. In this case the presentation wa.s a 
 posterior occipito-iliae. The labour lasted seven hours, and tho child weighed 
 MX pound-x. The a^'o of tin, oldest was 47. 
 
 Ca.mlfle.onuy the hIr/hs.-Ont of tho whole nun.ber of casualties nmonR 
 the b.rth.s, I find that 42 were born dead, and lU children were .till born. Of th, so 
 last the Hlatisties are as follow: of the 34 infants, there were 21 males and 13 
 temales. Of the males, attempts at resuscitation were successful in 17 eases and 
 unsuccessful in 4. Of the fen.ales, atten.pts at resuscitation were successful in 
 10 and unsuccessful in 3, exhibiting a total of 27 to 7, or thrccfourths of casca 
 of sti 1-born children, in which the eflorts for resuscitation have been crowned 
 with the most complete success. la all the eases which have occurred since 1854 
 the application of the stethoscope, and tho evidence furnished by it alone, as to the 
 action of the infant's heart, prompted the perseverance in the efforts for resuscita- 
 tion, which were frcjuently attended with success under the most unpromising 
 circumstances. And on tlii.s point I may remark, tluit experience has served to 
 convince me, that on, 10 account whatever, should the means for rcsu.scitation 
 be disc.mt.nued unt. that instrument, and that Instrument only, furnishes in- 
 conte;Uible proof of the cessation of the action of the heart. 
 
 With regard to the particular gestation in which the dor-ths and still-births 
 occurred, I g!e.m the followin,^ : of the 42 born dead, 27 were males and 16 
 were females. the n,ales 20 died in the first accouchement, 4 in the second, 
 and 3 in the third and subseciuent ones. Of the females 9 died in the first 
 accouchement, 2 in the second, and 4 in the tliird and subsequent ones. Of tho 
 still-b.r hs tliere were 21 males and 13 females. Of the males, 12 Btill-births 
 occurred in the first, G in the second, and 3 in the third and subsequent ac- 
 couckments ; and of the females, 9 occurred in the first accouchement, 3 in the 
 second and 1 in the third or subsequent one. These figures strongly corro- 
 borate 1 rof Simpson's views as to the influence of the male offspring in the 
 induction of difhculties. 
 
 The following general averages are deducible from the foregoing: that the 
 deaths of the infants were to the whole births as 1 to 46.4 ; that the still-births 
 were to the whole births, as 1 to G0.90, and that the recoveries in the still-births 
 were to the deaths in the same as 27 to 7, or nearly as 4 to 1 
 
 Duration oflabour.-ln 1094 cases of accouchement, the mean duration of 
 the labour was found to be 7 hears 3" minute.-,. The longest labour lasted 
 
 ik 
 
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 ^ 
 
 
 > 
 
 84 hours ; a Inhour of wich duration occurrod twice ; in both cnsoH malcH Were 
 born, in one iiiNtanco liviiif.'. in the other dead. The duration of tiio filiortest 
 labour was 12 minutes. 'I'ho time hero meant in the completion of the two flmt 
 stugoH of the labour or the birth of the child. I lind the comiiarativo duration 
 of the labours as iiillowrt : — 
 
 Under 1 hour 2t 
 
 From 1 to 5 hours 291 
 
 " 5 to 10 " 
 " 10 to 15 " 
 
 3'J4 
 254 
 
 15 to 20 " 82 
 
 from 45 to 60 hours 11 
 
 1 
 
 3 
 
 
 
 1 
 
 
 
 2 
 
 2 
 
 
 
 
 50 to 55 
 
 
 
 55 to 00 
 
 
 
 fiO to 05 
 
 
 
 05 to 70 
 
 
 
 70 to 75 
 
 
 
 75 to 80 
 
 
 
 80 to 85 
 
 
 
 85 to 90 
 
 
 " 20 to 25 " 78 
 
 " 25to;J0 " 29 
 
 «« 30 to;{5 " 1) 
 
 " 35 to 40 " 8 
 
 "40 to 45 " 2 
 
 In 1192 labours. 
 
 Titne between the rupture of the membranes and birth of child, — The period 
 of time intcrveiiin;:!; between the rupture of the membranes and the birth of the 
 child is recorded in 740 out uf the 1!H9 labours, and the mean time wa.s ascer- 
 tained to be 2 hours 48 minutes. The longest period was 71 hours ; the shortest, 
 contemporaneous with, or shortly after the birth of the child. 
 
 Dundiun (f gestation, — With regard to the number of days during which 
 gestation progressed, the greatest pains were taken to ensure accuracy, and out of 
 the whole number of patients admitted, there arc only 714 cases who.se infor- 
 mation can bo considered at all reliable. Tiie period taken is the time inter- 
 vening between the last day of the last catamenial flow, and that at which labour 
 commenced. Every one in practice knows the difliculty that exists in ascertaining 
 this period with precision. Tliese difficulties are enhanced in Hospital practice, 
 where there exists every motive for deception on the part of the pat lent. Retain 
 iug for the calculation all whose statements seemed probable, and rejecting all 
 which bore even the seeming of improbability, we have then 714 cases for the 
 basis of our statistics on this point ; and it will be observed that the results, 
 given below, bear out with singular exactitude the conclusions drawn from 150 
 gestations, and long ago published by Merrinian on the same subject, and subse- 
 quently quoted, I believe, by Churchill. The following are the results obtained 
 in the U. L. Hospital, of 714 women, at different ages. 
 
 4 were delivered in the 37th week; i. e., from the 252nd to the 259th day 
 
 37 
 
 (( 
 
 (1 
 
 (( 
 
 38 
 
 K 
 
 If 
 
 II 
 
 259 
 
 If 
 
 266 
 
 
 127 
 
 « 
 
 If 
 
 l( 
 
 39 
 
 If 
 
 If 
 
 II 
 
 266 
 
 ff 
 
 273 
 
 
 265 
 
 (C 
 
 « 
 
 (1 
 
 40 
 
 l( 
 
 If 
 
 If 
 
 273 
 
 II 
 
 280 
 
 
 157 
 
 (( 
 
 l( 
 
 (( 
 
 41 
 
 If 
 
 (f 
 
 It 
 
 280 
 
 II 
 
 287 
 
 
 85 
 
 (( 
 
 (( 
 
 l( 
 
 42 
 
 If 
 
 If 
 
 II 
 
 287 
 
 If 
 
 294 
 
 
 29 
 
 (( 
 
 (( 
 
 (( 
 
 43 
 
 If 
 
 (1 
 
 II 
 
 •lU 
 
 If 
 
 301 
 
 
 10 
 
 (( 
 
 (( 
 
 l( 
 
 44 
 
 If 
 
 II 
 
 II 
 
 301 
 
 it 
 
 308 
 
 
 I now notice the singular circumstance, singular, if the statements made by 
 the scvcirtil paticuts could bc iiupllcitly rcIicd OQ, that the register cuuiuCfatos 
 
a 
 it 
 It 
 
 6 
 
 two cases whoso gestation lasted onlv 0^7 i 
 
 in 22, on the 270th day; i„ 44 on the 27^^ l T'"' ^"^""' commenced 
 
 «nd in 17 on the 281st day. Then o„fo ■ ^' ^" ^^ °" ^'''^ ^SOth day 
 -von days, f^n the 282„d'to the 288th both "ff "°™"''^ '^'^^''^ ^'^ -' 
 folWng each other in the following order ' "fT^/: "'''^^" --''-« 
 
 number treated at their diffe ent g tadl l/1°"'"^' '^'"^^^ ^^--nt the 
 on ire truthfulness of the statenS ' i^^f? ^.^ '^ *^--" upon the 
 have been known to falsify their truo 1 I ""* ^^'^^ unmarried women 
 
 Hospital, to avoid the operation ^V^T^'t-""'' '""''^'^ "f entering" 
 possible, that unmarried females shJ ll ''^ '' "''"<^d °nt as strictTv Z 
 
 gw-e.e.doftl.r.tehild.l...^.^_„,^ 
 
 «6 « r f ' " 9 " " 
 37 « ^^'^ " « , ^^« 
 
 "«^^'^o/^/.e/,/„„,,_Thcwei.d>tnA. ■/ " 12 " 
 
 exclusive of the twin and JVJ^ °^ *'"" ^"^^nts is given in lisr; 
 
 ^^lbs.3o. TheheavS^a^^ir-. ,' '"? *^'--» --g w^ <S ^ 
 
 boy, who weighed, at term I^ 4Tb 1 1'"^, V, ^^^^ ^^ ^ ^ the" light: 1 1 ,' 
 
 anddid well.-lt was his mother ' tll^^ ' T'^'^' '^'^^^^^^ 17 inlhes 
 
 dimmutive weight to the severivoJ hi ''''^'^''-''^^^> ^ho attributed S 
 
 fiother was very intemperate WherH. ",'"' ^'"' ^'^^ undergone tII 
 
 Th:^ei:!::^^^^^^^^^^^ - ?-" "^ '" ^-^ '-'--^ - ^^ --" 
 
 ::r?- :^r^^^^"^^:^^^ 5;^ ^-?-^ - -^y i„ .t^rent 
 
 «g« weight is 7 Ibs'.^ '■' "' " ''' United States, according to B ef It ^ 
 In the 13 tw' o '" ^ecK, the aver- 
 
 -nymalesasferalerreZtrw^^^^^^ have record, which yielded as 
 
 the females 6 lbs fira n, i • *"' "^^''^ ma es was Clh« n / , 
 
 the greater T I ' /n ' '°^"^- *^'« average wei-dit nf M i '" °'- """^ "^ 
 fertater. ihe following is the loUiU-n ? /^'o'lt of the girls to be sli<rhtlv 
 
 whch occurred. No. 1, 5 lbs. 8 tV^'lt 1 "" *"P'^^« - "- only c^I 
 
 Itsaverage wei..f,f ^ ^«f«— Ihe weight of the Placenta ,\ rn„ .1 ^ • 
 
 fee weight was ascertained to !,<. 1 ii. a " recorded in 835 casps 
 
 1 oz. and occurred only once Pi ! ^^^ ^ '''~^^' heaviest weighed 4 11 
 
 ' 1 •• 
 
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 y 
 
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 « . 
 
 children doing well. It might be supposed that this apparent hypertrophy (if it 
 may be so called) was of a morbid nature. There is nothing in the record to 
 favour any such idea. The lightest one weighed 10 oz. It occurred also once 
 and m a primiparous woman, who al-o with her child, at term, did well. This 
 one also shewed no signs of disease. A placenta weighing 11 oz. also occurred 
 once, and cases in which they weighed 12 oz. were noticed 6 times. With two 
 exceptions these were also met with in primiparous women. The wei-ht of the 
 Placentas in the case of the triplets, to be hereafter mentioned, was e'lbs. 8oz 
 Battledore placentas were noticed 18 times, being onse in 46.3 labours 
 
 Length of the umbilical corcl-Tho length of the umbilical cord, was mea- 
 sured in 1180 cases ; Its mean length was ascertained to be 19.5 inches The 
 longest measured 47 inches. It occurred only once, and was four times encircled 
 round the infant's neck. The shortest measured 5 inches, and was nine times 
 noticed. Between the extremes of 47 and 5 inches, the record furnishes examples 
 of all the mtermediato lengths, some of course more prevalent than others. I 
 subjoin a table shewing the comparative frequency : 
 
 From 1 to 5 inches long, there were 11 
 
 5 to 10 
 10 to 15 
 15 to 20 
 20 to 25 
 25 to 30 
 30 to 35 
 35 to 40 
 40 to 45 
 45 to 50 
 
 
 61 
 
 235 
 
 377 
 
 326 
 
 113 
 
 41 
 
 12 
 
 3 
 
 1 
 
 The foregoing table excludes the twin and triplet cases. The mean length of 
 the umbilical cord in these cases was ascertained to be 18.5 inches. 
 
 Length of the in/ant.— The length of the infant is given in 815 cases It 
 ranged between 14 and 27 inches ; 14 inches was the shortest, nine of the infants 
 born having measured this length; 27 inches was the length of the longest of 
 which there were only three examples. The mean average length estimated from 
 the whole number of cases is 20.3 inches. The relative prevalence of the 
 lengths will be seen by reference to the following table.* 
 
 10 
 21 
 33 
 67 
 100 
 139 
 
 9 infants measured 14 inches. 221 infants measured 21 inches. 
 
 15 
 16 
 17 
 18 
 19 
 20 
 
 142 
 
 45 
 
 18 
 
 4 
 
 2 
 
 3 
 
 « 
 
 22 
 23 
 24 
 25 
 
 26 
 
 27 
 
 
 Caseaux, m his adrn'rable work "A Theoretical and Practical Treatise on Midwife! 
 of dCZr T f f '°"' ^«S°' '^'^^'^ th« fallowing remark, in alluding to the iuduction 
 of dystochml labours by excessive volume of the foetus: "That the largest children 
 are ne.er rnoro than twenty-thrcc inches from vertex to heel." The foregoing table 
 
 Zm^:^:: "'""* ""^^^ ^*° '^ P^^^^*^- ^•^^^^ ^^^ ^-^^ proportions ? oToi 
 815 infants whose measurements exceeded that length. 
 
 -.r 
 
8 
 
 JZot! '"''""' '*'''"""' "' "^''^' *^ "^^^ *^° ^°"°-"S S-eral 
 The mortality of the mothers was aa 1 to 114-G admissions 
 The mortahty of the infants was to the whole births as 1 to 46-4 
 Ihe still-births were to the whole birtlis as 1 to 60-9 
 The recoveries in the still-births were to the deaths as 4 to 1 
 
 TW T TH^S'^l """""^ *^' '^''^'''' '"'''"'^ chiefly in primiparous women 
 That the still-b.rths occurred chiefly with male offspring. 
 
 Ihat the chief mortality occurred also with the same 
 
 That the average duration of labour was 7 hours, 35 minutes. 
 
 That the average time intervening between the rupture of the membranes and 
 the delivery of the child, was 2 hours 48 minutes 
 
 ^ That upon the whole, the labours lasted longer with male than with female 
 infants and that the principal difficulties occurred chiefly with the fZer 
 
 Ihat by far the largest proportion of women were confined in their 40th week 
 
 iTw :7oX:s:' ^-^ ''''' '-'' ''- -'-'--^ ^'^'^-^^ -^-^ -^^ 
 
 That the average weight of the infants was 7 lbs. 3 oz 
 That the average length of the infants was 20-3 inches 
 That the average length of the umbilical cord was 19-5 inches 
 And that the average weight of the placenta was 1 lb 4 oz 
 In an ensuing paper I propose to analyse the labours, specifying the presen 
 sTrhoft ^''^"^"f'.^^^l^ ^^- -^^*- Fovalence all condude S a 
 
 of I f^Tf'T'" ''''''''''^ '" '^' "^°«* ''"P°'-t'^"t ca3c« of parturition 
 of wh ch the books of the Hospital contain a record, whether occurrin" i^ mv 
 own time or in that of my predecessor. occurring m my 
 
 Montreal, January 30th, 1860. 
 
 I 
 
 •Jl 
 
»g general 
 
 IS women. 
 
 ranes and 
 
 h female 
 ler. 
 
 'th week, 
 >y to the 
 
 presen- 
 
 with a 
 
 turition 
 
 in my 
 
 (2.) 
 
 In my first paper on the Statistics of flie University Lyin--in Ilospita], pub- 
 lished in the second number of the British American Journal, I considered in 
 detail all the circumstances connected with the cases treated in it as far as the 
 records permitted, with the exception of the labours themselves and their pecu- 
 liarities. These I reserve for a future occasion, and it is to these that I pur- 
 pose now to address myself; but before doing so I desire briefly to supply an 
 omission in not having alluded to the monstrosities observed during the currency 
 of the practice as more immediately appertaining to the subject of that paper. 
 
 Monstrosities, or the efl!'ects of imperfect development on the one hand, or of 
 superfluous development on the other, have been noticed six times since the'cstab- 
 lishment of the Hospital. Two infants were born anoucephalic, one of them 
 having had only a single nostril. Both lived a few minutes after birth. Another 
 infant was born wanting all the ribs from the second to the seventh on the left 
 side, thus exhibiting at each expiratory eflFort a deep soft sulcus through which 
 the heart's action could be distinctly perceived and felt. Superadded'^to these 
 defficiencies in the osseous organization of this infant, a like absence occurred in 
 the spinous processes of all the vertebras from the second or third cervical to the 
 last lumbar, constituting a Spina Bifida of no ordinary character. Thii 
 infant, strangely, imperfectly organized as it was, lived about twenty-four 
 hours. The fourth w.-s born with six fingers on the left hand, and a correspond- 
 ing number of toes on the left foot, these supernumerary appendages having 
 been removed by ligation shortly after its birth. The fifth one had Spina Bifida" 
 the posterior part of the third Lumbar vertebra being wanting. And the last one 
 presented a v^ry unusual appearance. " The parietal bones were separated by a 
 sagittal suture, 2^ inches in width. Attached to the integument were two tu- 
 mours one above the other, the one next to the cranium was smaller than the 
 one above it, and the deciduous membrane and amnion which enclosed the pro- 
 duct of conception extended to these tumours by a cord-like process and envel- 
 oped them." The patient who bore this child stated that she had received a blow 
 from a cudgel during her pregnancy on the left side of the abdomen ; the woman, 
 however, bore her child the full term of gestation, but it was still born, and died 
 soon after its birth.- It presented by the feet. 
 
 To proceed now with the more immediate subject of this paper. 
 
 Out of the 1949 entries in the books of the Hospital, I can only find 849 of 
 which a record of the peculiarities of the labour remains j and if to this number 
 
 ^l 
 
2 
 
 wc add tlio 354, whose statistics were f;ivcn in a vorj- n;cncral manner by the late 
 Dr. McCulloch in the British yimeriaui Journal of 18-47, and wliicli 1 now pro- 
 pose to make use of to the extent they permit, we liavo then the number of 1203 
 cases as the basis of our present statistical observations. 
 
 An inspection of tlie register will disclose the fact that the classification of the 
 labours adopted was the old one of " Natural, I'retematural, Laborious and Com- 
 plex," an excellent enouL^h one for ordinary purposes, but scarcely precise enough 
 for statistical uses. With the exception of tlie .35-1 cases which furnished the 
 basis of Dr. McCulloch's observations, whoso division in that paper I adopt as 
 suitable to my present purposes, I have carefully examined the details of the re- 
 maining 849 labours, exclusive of the multiple pregnancies of which I have the 
 record, and have reduced them to Naegele's system of classification, the one which 
 seems to me the simple and at the same time the most scientific and truthful, 
 Following, then, this system of classification, ^^e have the following numbers 
 of each of his four principal varieties of presentation : 
 
 Occipito-Iliac, II53 
 
 Sacro-Iliac, 33 
 
 Mento-Iliac 10 
 
 Cephalo-Iliac, 7 
 
 1203 
 Following up these four principal divisions, I find the following varieties in 
 the presentations : 
 
 1 Occipito-Illiac. — 1st Position 1101 cases 
 
 2nd " 28 " 
 
 3rd " 8 " 
 
 4th " 9 '< 
 
 5th " 3 '< 
 
 6th " 4 « 
 
 1153 
 
 2 Sacro-Iliac — Anterior 30 " 
 
 Posterior 2 " 
 
 Left Transverse 1 " 
 
 3.] 
 
 3 Mento-Iliac— Anterior 8 " 
 
 Posterior 2 " 
 
 10 
 
 4 Cephalo-Iliac — Left lateral plane 5 " 
 
 llight lateral plane 2 " 
 
 7 
 
 Total cases— 1203 
 
 While the Occipito-Iliac presentations are thus shown to exhibit the larwe 
 preponderance of about 9G per cent, of the whole accouchements, the other forms 
 of presentation show the following ratios : the Sacro-Iliac presen;: ,ns, 1 in every 
 3G.45 labours or 2.7 per cent. ; the Mento-Iiiao proseuiatiuus 1 iu every 120.3 
 labours or 0,8 per cent ; and the Cephalo-Iliac prct-entations, 1 in every 171.8 
 labours or 0.4 per cent. 
 
Bosiaes these cases wo have to enumenitc nineteen cases oF twins whicli in- 
 L'ludu tl;o,sc ciiunienitea by tlie hitc Dr. McCulioeh and one case of Triijlets. The 
 results of tiicso labours may be thus briefly noticed. 
 
 The offspring from the twin cases was 20 boys and 18 girls ; and with regard 
 to their mode of iiresoniation Ifmd that24 presented by the vertex and 14 by" the 
 breech or feet, and of the whole number, only one, a boy, was lost. Tlie pro- 
 portion of twins to the whole births bears a ratio of 1 to every ()3.;j labours. TI;o 
 relative wei-hts of the males as compared with the females in tiicsc cases were 
 detailed in my previous paper. 
 
 The triplet case allude^' to produced two boys and one girl ; of whom one a 
 boy was still born but afterwards die;!, although every effort was made to resus- 
 citate it. In this case the first presouted by the breech, and the otlicr two by 
 the vertex. The ratio of Triplet cases to the whole is as 1 to IUGS. Alluding 
 to niultiple pregnancies, Churchill furuishes the following comparative ratios froin 
 Hritish, German, an 1 French practice, that of twins 1 to 77;| cases, and that of 
 triplets as 1 to 5840 cases. 
 
 After these prefatory remarks let us examine the complications wliich have 
 been manifested in the different labours. 
 
 Among the Occipito-Iliac presentations I find the vertex complicated with a 
 collateral descent of one hand eigiit times; and with that of both hands once. 
 In seven of these cases the right hand was the one wliich descended along with" 
 the head, the hand most commonly placed near the ear. lu one case only"was it 
 the left hand. All these cases terminated favorably with one exception in which tho 
 child was still born, but was afterwards resuscitated by the usual appliances. This 
 latter case was additionally complicated with an cntortillcmentof the cord around 
 the child's neck. There was no appeal to operative assistance in any of these 
 cases. 
 
 There were four cases in which the presentation of the vertex became compli- 
 cated with a Prolapsus of the Funis to a greater or less extent. In two of these 
 cases the prolai^sed cord was returned and maintained above the brim of the 
 Pelvis, the infants having been born vigorously alive ; in a third case under like 
 circumstances the child wms still born, yet every effort at resuscitation was fruit- 
 less; and in the fourth case, the child had been dead for at least twenty-four 
 hours, as afterwards ascertained. But in this ease the vertex presented in the ;5rd 
 position, and although the funis was returned, it became necessary to resort to 
 the long forceps as the head had not become engaged in the cavity of the Pelvis. 
 This infant was of course brought into the world dead. 
 
 One Oceipito-Iliac case was complicated with mania, which declared itself four 
 days before the accouchement. Nothing pecuhar transpired in regard to this 
 €vent, nevertheless the maniacal symptoms continued for seventeen" days after- 
 wards, when she was di-charged without much amelioration of her condition, and 
 placed under the care of her friends, as the case had become no longer suited to 
 the Hospital. Another case of this cla,ss was complicated with epilepsy, to which 
 the patient had been subject for several years previously. In this case, tl-, pro- 
 eentation was natural, but in consequence of the supervention of an attack in- 
 
1 1 
 
 mediiite delivery was nocessitated. The child was bora dciul, and the woaian 
 died tivo hours after the accouchement had been completed. 
 
 In another case, the patient had been brought *o the Hospital comatose, and 
 had boon so lor fourteen liours previously, the coma having resulted from puer- 
 peral convulsions, of which no less than seventeen fits had occurred before her 
 admission ; it does not appear that the woman liad received any treatment prior 
 to her admission. The forceps wore used in this case, — the child was born dead, 
 but the mother recovered and was discharged on the fifteenth day afterwards. 
 In another instance, convulsions threatened after the delivery of the child and 
 before that of the placenta. The timely employment of the lancet, and imme- 
 diate extraction of the after-birth arrested the further progress of the symptoms. 
 
 Another case was complicated with extensive redema of the labia majora. After 
 labour had commenced, the labia were punctured, which cifectually removed any 
 obstacle to the delivery which might have been afforded by this condition of the 
 vulvar aperture. It was this patient's first child. 
 
 A rather singular complication was exhibited in another patient. After ad- 
 mission she became affected with jaundice which necssitated lier removal to the 
 Montreal General Hospital, where shortly after her entraiice severe cerebral symp- 
 toms manifested themselves accompanied with violent delirium. This condition 
 terminated in puerperal convulsions wliich continued until her death, which took 
 place a few hours after her delivery, which was effected by Dr. Craik, the house sur- 
 geon of that Institution, artificially. The child in this instance Wiis born dead. 
 I was informed that at t''0 autopsy which took place, the liver was found very 
 much atrophied. 
 
 As apparently connectcu .vith this case, I may incidentally remark that one 
 or two cases of a somewhat similar character occurred in private practice about 
 the same time. I saw one of these cases with Prof. Holmes. Siie was married 
 and in the sixth month of her second pregnancy. She was taken ill on a Friday 
 with the premonitory symptoms of jaundice, which declared itself more and more 
 unmistakably until she was first seen on the following Thursday by Dr. Holmes. 
 On the Iriilowing day severe delirium set in succeeded by coma, at which period 
 I saw her. She died early on the following day. At the postruiortem examina- 
 tion of this case, the liver was also found considerably atrophied, especially the 
 left lobe, of an intensely yellow colour, and so soft as to break down readily un- 
 der the finger. This case furnished the material for an important monograph 
 from the pen of Dr. Holmes, which appeared in the Montreal Medical Chronicle 
 for Jaimary 1856. 
 
 One case occurred in which the vertex presented, complicated with additional 
 presentations of the left hand, right foot and Funis. This very rare complica- 
 tion ,as reported in the same Journal for June 1855, by the gentleman in 
 attendance upon it, and I will allude to it more particularly hereafter. 
 
 One case of laceration of the perineum occurred, and in a rather singular man- 
 ner. The presentation was normal, but complicated by severe, occasional spasmo- 
 dic rigidity of the lower extremities. These liaving been considered as not in- 
 voluntary, the patient was cautioned very emphatiealiy not to perniil them. Not- 
 withstanding this caution, she closed her thighs on the head of die fcetus when 
 
 i !( 
 
it was pressing on tlie perineum, and tlie opclpiit bcL^inninc- to emerf^e. This 
 forced the face violently against tlie perineum, and notwithstniiding every exer- 
 tion on the purt of the gentleman in attendance to prevent it, the perineum yield- 
 ed, and a considerable laceration took place, which was afterwards treated in the 
 usual manner. 
 
 Cases of Placenta ProBvia occurred three times: in two of these intanees the 
 placenta was only partially implanted over the os uteri, and in the other case, 
 completely. I will notice this latter case on a future page. 
 
 Rigidity of the os externum uteri was frequently observed, but very seldom 
 as offering any serious impediment to the progress of the labour. Eight cases 
 are on record however, in which this condition of that part very materially pro- 
 tracted the labour, and became in fat the real obstacle, demaiuliiig the employ- 
 ment of energetic moans ta subdue it. In one case I find tliat Belladonna 
 inuntions had been resorted to without the slightest apparent effect ; and after 
 several hours had elapsed, it was finally subdued by the exhibition of twenty 
 minims of Vin. Ipecac, every hour. The ordinary method pursued now in these 
 annoying cases, which, while it rapidly subdues the rigidity, at the same time 
 saves the time and anxiety of the attendant, is the administration of one grain 
 doses of Tartar Emetic given every lialf hour. I have rarely been eompcll d to 
 administer more than two such doses, while in the large majority of cases, 1 have 
 usually found it to yield in the course of twenty or twenty-five minutes aftei 
 the exhibition of the first dose. 
 
 In one case the child was dead born at full term, covered thickly with the 
 copper coloured rash of tert.ary Syphilis. The infant had not been long dead, 
 as the skin evinced few of the signs of maceration. It occurred in tlio case of a 
 married woman, who does not appear to have ever .suffered frum any ofthi; 
 primary symptoms of that affection, although occasionally hereelf covered with a 
 rash for which she could not account, but which had yielded to the medical 
 treatment adopted from time to time as it appeared. 
 
 Nineteen cases of Puerperal fever occurred in the Hospital at different periods 
 since its establishment, and in every instance necessitating its temjwrary closure. 
 One of these eases, although I place it und r this head, was an uuiuistakable, and 
 well marked c ise of Uterine Piilebitis, in which the formation of .secondary 
 abscesses took place in the joints of the elbow and wrist. This woman recovered. 
 Of these cases seven terminated fatally, and the fortunate issue in the remaining is 
 chiefly attributable to the very prompt treatment to which the patients wcic sub- 
 mitted after the existence of the disease in the Hospital had been too emphatically 
 realized. 
 
 Seven severe cases of Uterine IToemorrhage occurred, five before the delivery 
 of the placenta, and two after. The Hmuorrhage in all these CJises was control- 
 led by the usual means, no ulterior bad consef|uences having resulted. 
 
 As a matter of curiosity I now record the following circumstance which is 
 certainly curious, if true, and there does not seem to exist any good or sufficient 
 ground for doubting the woman's veracity, as she could have gained or secured 
 nothing by the falsehood whatever, if one. This patient, a respectable looking 
 married womm, 40 years of age, and the mother of four previous children. 
 
decl:irc(l that she liad not perceived any catainenial flow whatever, since tlio birth 
 of iior fourth child, tlion six years of a-o. I think this may be set down as 
 another instance of the vagaries, sometimes cxliibited by Dame Nature lu the 
 performance of this function. Ecjually Hin;j;uhir anomalies are on record. 
 
 The forceps were employed in nineteen in-<tanees, the sliort forceps seventeen 
 times, and the long forceps twice. One case in which the latter was used has been 
 already alluded to, and the other was one in which contraction of the antero-pos- 
 terior diameter of the brim existed, and the attempt to deliver having been in- 
 effectually made by this instrument, it was afterward effected by version. Tlu- 
 chief features of this case will be detailed afterwards. In the seventeen short 
 forceps cases, the child was extracted dead in two instances, the bodies having 
 exhibited the ordinary signs of death having taken place some days previously. 
 In one of these cases the child was not only dead, but both it and the placenta wen- 
 very considerably decomposed. In the other two cases, the infants wero born 'still.' 
 To both the usual means of resuscitation were applied, but only in one case 
 with success. In the remaining thirteen cases the infants were living when born. 
 In only one case was the issue unfavorable to tlie mother. I will give an ab- 
 stract of this case also shortly. 
 
 Podalic version was performed six timoF-.. In five of these cases the pre- 
 sentations were some portions of the intant's lateral planes. In the sixtli 
 case, it was performed to convert a vertex into a footling case, and effect the 
 delivery through a contracted brim, which did not appear possible in any man- 
 ner, except by means of craniotomy. I have briefly alluded to this case in the 
 last' paragraph. In one instance of arm presentation, the late Dr. ]\IcCulloch 
 succeeded'' by means of external minipulttion, (a practice again lately urged 
 ibr adoption more generally,) in bringing the head to the brim of the pelvis, thus 
 avoiding the hazard of this operation. 
 
 No cases have as yet occurred in the Hospital, reriuiring the performance of 
 any of the other obstetrical operations, a matter of some congratulation. 
 
 A word lastly as to the general employment of chloroform. During the at- 
 tendance of the late Dr. MoCuUoeh, as well as since I have had charge of the 
 Hospital, chloroform has been but sparingly used ; its general use is pi-ohibited 
 in all ordinary labours ; but it is employed whenevcjr anything untoward occurs 
 which demands an artificial assistance. It has accordingly been employed in all 
 the cases of version, and in forceps cases, after the blades of the instrument have 
 been introduced and locked. Such are the cases to which its employment has 
 been as yet restricted, because no others have as yet occurred to require it. 
 
 I will conclude the.«e statistics, by giving in as short detail as possible, the par- 
 ticulars of some of the principal and most important cases which have occurred 
 in the Hospital since it was opened; and to render these observations as 
 complete as possible, I will place under contribution Dr. McCulloch's commu- 
 nication in a former series of this Journal, previously alluded to, as also that of 
 Dr. Fenwick. 
 
 MoNTHEAi., April 25th. 1860. 
 
 \ 
 
l-l 
 
 \ 
 
 (3.) 
 
 1 will now coucluJo these observations by reporting as briefly as possible 
 the leading features of some of tJie more important cases which have occurred 
 in the Hospital since its establishment. 
 
 Case I.— Ca^c of twins. Concealed ddivcri/ of one child. This important 
 case, of which I propose to give merely an abstract, was reported at length by 
 Br. S. C. Sewell, in whose practice it occurred, in the 2nd Vol. of the old series 
 of the British American Journal, for 181G. Tt possesses important medico- 
 legal bearings. 
 
 On the Kjth November 1845, Dr. Sewell was requested by a gentleman, a 
 patient of his, to visit his servant woman, Bridget Cloono, aged 40, who 'he 
 stated, was suffering from colic and pain in the back. After arrival at' the 
 house. Dr. Sewell was Induced to suspect a pregnancy, which was confirmed by 
 vaginal examination. He estimated the gestation to have been about seven or 
 eight months. Upon being charged with it, the woman indignantly denied 
 the impeachment, but admitted, that " if there was anything inside her it was 
 no child." She was immediately removed to the U. L. Hospital, where on 
 examination, one hour afterwards, Dr. S. found the os uteri dilated and the 
 membranes protruding, indicating a conceakd labor in progress. He then 
 detected what appeared to be a funis lying coiled in the upper part of the 
 vagina, on pulling which, a free extremity came down but not to the vulvar 
 aperture. Dr. Sewoll left, and on returning shortly afterwards, he found 
 Dr. McCulloch in attendance, a child having been just delivered by the feet, 
 and the woman still persisting that there was no child. It is necessary now 
 to notice that the extremity of the free funis presented every appearance of 
 having been cut by a pair of scissor.s or knife. Information of the circum- 
 stances was lodged at the Police Office, and on examining her trunk of clothing 
 at the house of her master, the body of i> male child was found underneath 
 the clothes which it contained, these having been carefully smoothed over it. 
 
 Without entering further into detail, it will suffice to enumerate the con- 
 clusions arrived at by Drs. McCulloch and Sewell after a post movtan examina- 
 tion, performed by order of the Coroner : 
 
 " 1. That the child had breathed freely. 
 
 •■' 2nd. The marks of injury on the right breast and neck were inflicted 
 during life. 
 
 " 3rd. They were in all probability caused by the left hand of an adult 
 grasping the neck of the infant. 
 
AJf 
 
 M 
 
 16 
 
 " 4th. The protrusion of the tongue and the position of tlie hands arc pro- 
 bably referable to strangulation. 
 " 5th. Death was not cau.scd by liccuiorrliage from the cord ; and 
 " 6th. The child was between seven and eight months of utero-gcstation." 
 To conclude this case using Dr. Sewcll's own words when narrating it ; 
 " the rest of the evidence went to shew that she had been a widow for .some 
 " years ; that she had carefully concealed lur pregnancy ; that she had taken 
 " powerful cmmenagoguc medicines prescribed by an irregular practitioner up 
 " to the day of delivery, and that she was seen half an hour before Dr. ScweU's 
 " arrival at the house, to get out of bed, stand by its side, take a pair of scissors 
 '• from underneath the pillow and rut wmething under the bed chthcs." There 
 seems to be an incongruity in the latter part of this statement, the italics of 
 which are my own. The cord could not have been divided under the bed 
 clothes, she standing at the time by the bed side, as the shortness of the 
 cord lying in the vagina, evidently indicates it to have been severed close to 
 her own person, furthermore proved by the length of the cord attached to 
 the infant wliich was found to be nine inches. I cannot explain this apparent 
 discrepancy. The result however of the case was, that the coroner's Jury 
 returned a verdict " of wilful murder " and she was immediately put under 
 arrest. The bill of indictment founded upon this verdict was afterwards thrown 
 out by the Grand Jury. The woman was then indicted for concealing the 
 birth of an illegitimate child, convicted, and sentenced to six months' imprison- 
 ment. It is not only unnecessary, but out of place here, to consider the im- 
 iwrtant medico-legal bearings of this case. 
 
 Case 2. — Turning hi/ external mam'puhition In a trunk prcmentation. 
 Mrs. McM. was admitted on the 24th July 1852, and labour set in on the 
 following day. The membranes had not ruptured, but on vaginal examination 
 a hand was detected presenting at the os uteri. Dr. McCulloch was notified 
 of the circumstance and was in prompt attendance. The right liand was now 
 diagnosed to be the presenting one ; and by careful examination, the head of 
 the foetus was distinctly felt in the right iliac fossa. Instead of turning 
 the child, he determined to attempt to bring the head to the superior strait. 
 By a series of well managed external manipulations he eventually succeeded in 
 displacing it from the right iliac fossa, and lodging it over the brim of the 
 pelvis where it fortunately remained. A rupture of the membranes, with the 
 consequent increase in the force of the uterine contractions, maintained it in 
 its po.sition, and it advanced along with the hand, which it was found 
 impossible to return. The shoulder became pressed under the chin, and the 
 forearm and hand became extended along the face and parietal bone. The child 
 was born alive but died thirty hours afterwards. The parietal bone was found 
 to be distinctly indented by the hand and fingers of the infiint at the time of 
 its birth. 
 
 I think there can be no doubt that version performed by external manipula- 
 tion, may be far more frequently resorted to than it is, and that this means of 
 converting an unfavourable presentation into a favourable one has been to a very 
 great extent lost sight of. It is scarcely taught in the schools, and rarely alluded 
 
 ^■s 
 
 »V 
 
L 
 
 17 
 
 to even in obstetric : works, but it is an operative procedure of great merit uu.l 
 should bo nttempteu in nil eascH, mho accoucheur is fortunate enough to sec his 
 patient before the membranes have ruptured, some portion of the infant's lateral 
 piano prcscntmg, the head not very remotely placed from the centre of the bri n 
 of the pelvis, and at the same time no unfavourable complications existing which 
 may demand a prompter termination of the labour than this method affords whethrr 
 for the sake of the mother or the child. Under such circumstances, 'this me- 
 thod should be adopted in preference to submitting the mother and her infant 
 to the hazards necessarily encountered -•.) the performance of podalic version, 
 Acaseocourre'i in my own private practice about three months since, which exhi- 
 bits the feasibility of the operation, and the comparative ease with which at least 
 in this instance, it was performed. Mrs. McH , whom I had twice pre- 
 viously attended in her aecouehements, .«ont for me in her fifth. In the fourtli 
 labour the infant presented by the breach, but beyond this all went well in the 
 prceeding ones. She was tall, and rather slenderly built, but well proportion^ 
 Ihc labour liad been in progress about a couple of hours before I arrived at her 
 house, and on examination, I found the os uteri dilated to about tlic size of a 
 crown, the membranes protruding to a slight extent, and enclosing, what after 
 some difficulty I made out to be an elbow. The globular form of tho foetal 
 head was distinctly enough traceable in tho left iliac region. Bearing in mind 
 the success obtained in the exsc above reported, I resolved, as the uterine action 
 was not urgent, and intervals of several minutes occurred between the pains to 
 attempt to bring the head to the superior strait by means of external manipula- 
 tion. Placing one hand on that portion of the abdomen opposite the child's 
 head, and the other on th'j part opposite its nates, by gentle pushes and im- 
 pulses, I felt the head, after about twenty minutes manoeuvering, gradually 
 receding from its position ; and at an ensuing vaginal examination, I had the 
 satisfaction of feeling tho vertex, the elbow having completely disappeared. By 
 this time the pains had become more rapid and efficient, and were fast losing 
 their primitive character. A severe bearing down pain soon came on during 
 which the membranes ruptured, and in the course of about an hour afterwards 
 the vertex presented at the vulvar aperture in the first position. I am fully of opi- 
 nion that this procedure may be more frequently resorted to than it is. After the 
 membranes have ruptured, this operation becomes impossible. 
 
 Case 3.— Presentation of tie vertex, comjiUcatcd with prolapsus of the funis, 
 left hand, right foot, and left latiral plane. 
 
 This case occurred since my connection with the Hospital and was reported 
 in the Montreal Medical Chronicle for June 1855, by Mr. (now Dr.) Kollmyer 
 the gentleman who was in attendance upon it; I will therefore give a risumi 
 of it 
 
 Bridget B. aged 28, married, strong and healthy, applied for admission into the 
 U. L. H. on tho 23rd March 1855. Tho present is her fourth pregnancy 
 nothing untoward having occurred in her previous aecouehements. 
 
 Labour supervened about 10 A.M. on the morning of the 22nd AprU and 
 having been summoned, Mr. is., found on examination, the os uteri thiok mosit 
 
18 
 
 cool, and yitil<Ui|. tk pauw c, , inued, aud the ii„ mbrauee ruptured about 1 , 
 I', M. when a tw^ forge <|uoatity t,i li.juor aranii cscoped, 
 
 On cXOMlMtfM Imtnediitcly nller this cvenr. a loop of tltf' Bnif»ilical cord 
 prcdcnfod itwlf exiiirnally, but uo other proMcntitif,' pint could bo reached by 
 fh(i firi-er. TMiniVmg u .1 case for ver»io» a /lose of opium was adiuiniKtcrcd, 
 ami I wuM s«,i Sor, On my nrrival at the hoH{,it»l, after introducitif; a con- 
 Kiderablo portion ».f llm /,Hn/f: I detected the occiput presenUi above the brim, 
 and inclined tcvards fae luotiht-r's ri^ht sacro-iliac nynchondroMH, but so much 
 M.) ii.s to imprcHs me with tho idea that the labour mi-ht terminate spontane- 
 ously, if no other (ibstaele intervened. A little to the left of the occiput a 
 careful examination still further detecte.l a f„ot, which was diagnosed to 'bo 
 the ri-ht one, and u little hi-her up a hand, which turned out to be tho left 
 one, while stretched across the brim of the pelvis l»y the child's left lateral 
 plane, and the umbilical cord still pulsatin- was prolapsed. J{y th.; application 
 of the stethoscope the pulsations of the fcetal hearl were heard, and counted at 4I» 
 in tlKMuinute, thus indicating the extreme dan,t,'er in which the child was placed 
 r at lirst inmi;ined that 1 had to deal with a case of multiple prc-nancy but 
 m carefully cxaminin- the fact wiw ascertained that the funis, fijot occiput 
 and hand all appertained to the same child. An attempt was made to return 
 the prolapsed funis, and j.ush up tho inferior extremity and body m as to 
 permit a more complete en-a-emcnt of the occiput, but the powerful uterine 
 jBtioi -^ich was goin- on utterly precluded this mananivrc. By this 
 time Hi., pulsations in t!u« cord liad ceasc.l. Havin- resolved upon the 
 immcd.ute operation of version, chloroform was administered, and when 
 its amcsthetic influence had been secured, I proceeded to its accom- 
 plishment, by seizing the right foot, and bringing it into tho vagina, where 
 it was secured by a fillet ; with some difliculty I next succeeded in seizing tho 
 other foot, and the labour then progressed as usual until the delivery of the 
 arms. With very great difficulty tho posterior or sacral arm was made to 
 effect its curve over the child's chest, but all attempts to perform the same ope- 
 ration with the anterior or pubic one proved unavailing. This arm was found 
 to have become crossed behind the child's neck and rested on the brim of the 
 pelvis. This difficulty necessitated a rccour.se to the blunt hook. This instru- 
 ment was passed upwards along tho back of the child, and fastened upon the 
 shoulder, which was brought by careful traction into the cavity of the pelvis 
 where afterwards manual interference effected tho disengagement of tho arm! 
 The head was finally extracted after considerable exertion. 
 
 Tho child, which was born dead, was unusually large. It weighed 10 lbs 
 i oz., and measmed 26 inches in length. The funis was also unusually long 
 having been about 28 inches in length. The duration of the labor was about 5^ 
 hours, and the mother recovered well. 
 
 Case 'i.— Presentation oj ' c V,'.Hex, complicated hj projection of the Pro 
 tmntory of Sacrum; rigiHty . i :• uteri, >^ orifice; ineffectual attempts at 
 delivery by the long forcep<i ; ^oe^i'.i i...'r-.>,«. successful 
 
 Mrs. EJiza Fceny, a manioc? ;>.< ;ar, stout and /-roiis, aged 37 years, in 
 her second pregnancy, was ad^.Uwd ,; k.. the TJ. L. iiospital, at 10 a. m. of the 
 
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vi^ 
 
 * fi* 
 
 1' 
 
 19 
 
 r„i„';!; •""''■• '"'"■ "■■'■ '■'"'"'• ^"■■"' — "■' «•■' ...... .ha. ».. 
 
 Immodiutcly after her udmittaneo a copious ,t .hariro of I. . .- . 
 place AtU.„.la„..eon thi.s ea.., havin, flJle: iJ JZ :M '(ITw ' 
 nynKlwu,.. that Kcntlon.a,. was inunedia.ely M.n.na.ned In . ii tl " rV ^ 
 hav ni,' been seen bv liim sl... ,.»...» i • i """"'"ca. m a httlo while after 
 
 "U.-i„e action. The ioHowin. was tiie n.ixture ""''^"™ "' *'" 
 
 Antim ct Potassa) Tartrat, irr. vi. 
 Morpliino Mur. J>!oIut. (I'h. E.) 3 i. 
 Aquao 5 vi M, 
 
 Capiat 5 j. (jiuKjue (,uarta parte hora-. 
 By the ti.ue ,.he had taken three do.es of the niedicine, I arrived at the Ho. 
 
 contuinzng a drachn. of the solution of the n.uriate"? ml 'was e.tZ. 
 internally. It was now about 5 p. ni ■ .md »nAor ih exhibited 
 
 uterine aetion would beeon.e moi/r " ulai „d eff L 'T'""" '^'' '^' 
 
 gained forward a loop of the PuL whieh it Z fm.nl u "" "' '' 
 
 thus additionally eom^plieating the eak'tuLZ 
 
 felt in ,t. On consultation it was now deemed advisable to ha recout^^^^^^^^^^ 
 long forceps, wh.cl, were repeatedly applied by myself, and arrw^ds bv Dr 
 Holmes, but which as often slipped off the head It w.. 1! ? 7 
 
 to have recourse to version Thn n«f;« . T 1' ""^ '""'"^^'''^ "Pon 
 
 now exhausted. I request"'! J)- f-b _ ' """. ""'^"^"as the other, but 
 
 w«. af.r powcrf. i^^U.e' *;- T^ j'':;:-^"' ^S 
 
 t I 
 
20 
 
 was born dead, but the mother, notwithstanding the severity of her labour, 
 made an excellent recovery, and was discharged from the hospital on the 7th 
 
 ^T&ld in the remarks on this case in the ward-book of the hospital, that the 
 biparietal diameter of the child's head measured 4^ inches, and that the antero- 
 posterior diameter of the brim of the pelvis, ascertained by digital measure- 
 ment, was only three inches. The following additional peculiarities in regard 
 to the child are on record: Its length was 24 inches; its weight 101b. 8 oz; 
 and the length of the funis umbilicalis was 45 inches. It is worthy of remark 
 that her accouchement, two years previously, was only of two hours duration, 
 that child was then living, nothing unfavourable having occurred. _ 
 
 Case G.-Vertex presentation in the left Transverse position, compli- 
 cated with generally contracted diameters of the brim of the pelvis, and an 
 
 exostosis of the Right Sacro-iliac Synchondrosis. Forceps. 
 
 M N. G., an unmarried primipara, aged 30 years, of short stature, stout and 
 active was admitted into the U. L. Hospital on the 22nd January, 1855, and abour 
 came on the 18th March at G a.m. As soon as possible aft.r this was known 
 the gentleman to whose charge this case fell was sent for. This party confident 
 in his own powers, and too proud to consult the matron with whom he had had 
 an altercation some time previously, was resolved to manage it exclusively him- 
 self, which the matron, grossly neglecting her duty, permitted him todo In 
 fact he stated that he had enjoyed an extensive midwifery practice in Upper 
 Canada in the place where he resided, and was therefore competent to any emer- 
 gencies which might arise. The unfortunate result of this case proclaims how 
 shamefully he violated his obvious duties. He arrived at the hospital at about 
 
 ^ From this time till about 11 a.m., the pains were light with considerable in- 
 tervals between them, but they now began to be more active and efficient. 
 An examination was made, which satisfied him that the infant was presenting 
 by the vertex. The os uteri became nearly fully dilated about 3 p.m., when the 
 pL changed to the ordinary bearing down ones. Matters continued in this 
 stat« with the exception of increasing intensity m the pains, and but littken- 
 .agement of the head in the cavity of the pelvis until 6 o clock the »«*«>«"»»?; 
 Ihen he at last deemed it his duty to send for me. I arrived at the hospital at 
 7 am and on careful examination discovered a transverse presentation of the 
 vertex a very large caput succedaneum, and marked heat and tenderness 
 throughout the whole length of the vagina, especially about the os uteri The 
 h^tttr however, was well dilated, and the head had become very considerably 
 ent^d within the brim of the pelvis, but closely impacted. The apparent con- 
 dition of the patient was by no means promising. Her countenance was expres- 
 sive of anxiety and very much flushed, the pulse was quick and hard, the pains 
 powerfully bearing down, with very short intervals. There was no other 
 Ele but the immediate application of the forceps. The head was low 
 fTTLn to permit the use of the short pair, which were therefore used. 
 With considerable difficulty 1 succeeded in applying them, an^ro-posvenor.y un 
 the 'hild's head, and after considerable tractive force, the head was withdrawn. 
 
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 21 
 
 The child was still born, and small, weighing only 6 lbs. 8 oz. ■ and although at- 
 tempts at resuscitation were made, and continued perseveringly for nearly an 
 hour, they proved fruitless, the heart's action ceasing in the course of three 
 quarters of an hour. 
 
 The mother progressed favourably until the fourth day, when symptoms of 
 pelvic cellulitis began to manifest themselves. In consequence of this she was 
 removed to the Montreal General Hospital. An extensive abscess formed within 
 the cavity of the pelvis on the left side, which was opened through the vaginal 
 wall, permitting the escape of an immense amount of intensely foetid pus She 
 died, however, on the 23rd of April. The pelvis forms a specimen in the patho- 
 logical museum of the Faculty of Medicine of McGill College. It presents some 
 sight obliquity; the internal plane of the Ischium on the left side .shews evi- 
 dent traces of caries. There is a considerable exostosis on the left Sacro-Iliac 
 Synchondrosis, and a thorough anchylosis of this articulation on both sides. 
 Ihe anteroposterior orconjugatediamcter of the brim measures .3,3, i„ches and 
 the transverse 4j\ inches. ' 
 
 There can be no doubt that this unfortunate creature would have survived her 
 accouchement had a more timely assistance been afforded. 
 
 Ca.ses 7-U.-.Vertexj>resentations complicated with rigidity of the Os Uteri 
 These selected cases are of no further moment than as tending to establish 
 the value of a practice suggested by myself in the December number, 1850, of 
 the old series of the BnUsh American Journal, in which there appeared a paper 
 confirmatory of the utility of Tartar Emetic, exhibited in such cases in one 
 grain doses, given every half hour. This practice was at the time supported by 
 the effects witnessed in four cases of parturition, complicated with excessive 
 ngidity of some part of the uterine orifice, and these selected. I deem it unne- 
 cessary to enter into the peculiarities of these cases, as their phenomena were 
 nearly aU alike. K.gidity of the Os Uteri presents nearly the same phenomena 
 in all cases; except that the rigidity maybe partial or complete, involving 
 one portion or another of the uterine orifice. The above, however, are 
 cases in which the labour wa.s prolonged by rigidity of the whole external 
 orifice, which acted as a tight band upon the vertex, prohibiting^ its advance. 
 .VII these cases were managed in accordance with the principles contained in the 
 paper to which I have adverted, viz : the exhibition of grain doses of the Tar- 
 tar emetic, exhibited every half hour. In no instance was it necessary to repeat 
 the Tartar emetic more than twice ; one dose most commonly sufficing. It is 
 my opinion that the value of exhibiting the remedy in the way indicated over 
 bleeding, Belladonna, or the same medicine given every four hours in smaller 
 doses as commonly advised, is unquestionable, and I adduce these cases as addi- 
 tional ones confirmatory of the fact. 
 
 mT V^7^f«'^J«i'''-^*'«; ^"i^"^ ^P^loion of the u-holc uterine contents. 
 
 Hn!l' y fTt k" "^'^ ^^' "PP"'*^ '' "^^ '' ^ ^^™i*^d into the U. L. 
 Hospital, about the beginning of December, 1846. I„ consequence of puerperal 
 
 lTA""^'"•"l^*^'^'^'^*'>^I-''^"^-» «* this period, admittance 
 ^... .enxcu, bu., at the same time, the promise of a.ssistance was extend- 
 ed to her in her own house, when the appointed time arrived. From the 
 
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 answers returned to my questions at this time, I expected that the case would 
 turn out one of Placenta Prsevia, a suspicion which was afterwards confirmed. 
 Symptoms of labour set in on the 17th of the same montli, and licr husband 
 called at my house to notify me of the fact at a.m. of that day. I immediately 
 placed her in the charge of Mr. (now Dr. D. T, Robertson), a most intelligent 
 pupil of my own,who immediately accompanied the husband. I should now remark 
 that, within a few minutes after having been notified of the case, I was sum- 
 moned to attend upon a lady who had engaged my services some months pre- 
 viously, and as the house in which Mrs. T. lived was but little out of my road to 
 that of my own patient, T ventured to pay her u short visit, to assure myself 
 of the state of affairs, and to assist Mr. 11., if necessary, to the fullest extent my 
 own limited time permitted. Mrs. T. was a short stout woman, in her sixth gesta- 
 tion, her previous ones having been all ordinary. On examining lier, after 
 entering the house, I found the os uteri dilated to nearly the size of half a 
 crown, soft and dilatable, the pains active, but not very efficient, the placental 
 mass completely blocking up the orifice. There was, of course, the usual 
 hsBmorrhage, but it was by no means profuse. In fact her pulse was scarcely 
 affected by what she had lost, and was losing. The case admitted of some delay, 
 and as my own time was very limited, not permitting me the application of 
 the stethoscope, to ascertain the condition of the child, or the extent and nature 
 of the placental engagement, I advised 31r. R. to send for Dr. Fcnwick, then 
 Registrar of the Hospital, and in the mean time to apply the tampon to moderate 
 the haemorrhage. That gentleman was accordingly sent for, and as he has re- 
 ported the case in the Medical Chronich for 1847. T quote the conclusion as 
 detailed by him : 
 
 " I saw the woman shortly afterwards. On examination I found the placenta 
 almost wholly detached, and bulging out though the os, which was dilated. The 
 pains were lingering, and by no means severe. With each pain there was a 
 slight gu.sh of blood, but the quantity lost was so trifling as not to have affected 
 the circulating system. I explained to her husband that manual interference 
 was necessary, and while preparing myself for the immediate performance of 
 version the patient was seized with a prolonged smd vigorous pain, 
 and as I passed my-hand beneath the bed-clothes, the placenta was shot out with 
 considerable force over my knuckles, and the child immediately followed. The 
 uterus contracted firmly, and all was well as regards the mother. The child, 
 however, was dead." 
 
 Nothing requires to bo said about the other two cases of Placenta Proevia, 
 both of which were " partial." The ordinary management was adopted, and in 
 both cases the infants born were living. 
 
 The foregoing is a sketch of some of the more important cases which have 
 occurred in the Hospital, from its establishment to the present period. I have 
 given them as an appendix to the two papers previously published. 
 
 Montreal, 1st July, I860. 
 
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