THE
MEDICAL EXAMINER,
AND
RECORD OF MEDICAL SCIENCE.
NEW SERIES.—NO. LXX.-OCTOBER, 1 8 50.
ORIGINAL COMMUNICATIONS.
Contributions to Obstetrics, with Tabular Views, and Miscellane-
ous Practical Observations. By Henry A. Ramsay, M. D.,
Raysville, Georgia.
Contributions to obstetrical science from the South are so rare,
that I have concluded to present the results of my restricted experi-
ence, in this department, in a tabular and commentative form,
which, however lame in practical importance, may elicit farther
details, and furnish some data for determining the comparative
state of rational midwifery in the Southern country. The field of
obstetrical observation in the South being confined largely to our
black population, presents at many points advantages for the
practical elucidation of obstetricy nowhere else to be obtained by
the professional man. At the present day a large majority of the
obstetrical cases among this class, are exclusively under the con-
trol of the physician, and I am happy to add, the white ladies of
Georgia are fast falling into ranks, in reference to this important
point. Wherever our black population is dense, and their condi-
tion healthful, they increase with an almost unparalleled rapidity,
and are unusually prolific ; and such is the care with which they
are provided for by their owners, to secure these desirable ends,
that we hazard nothing in asserting that the negroes 6f Georgia
are better provided for, obstetrically and dietetically, than any
other dependent class upon this continent, private infirm cades,
public hospitals, alms-houses, pauper cliniques, and lying in hos-
pitals, to the contrary, notwithstanding. The planters have theii
family physicians, who have the exclusive control of the blacks,
and who are called without reference to simple or emergent cases,
and without regard to expense. Since my advent into the pro-
fession, it has been my good fortune to attend several hundred
cases of labor, embracing almost every variety, from the simplest
to the most difficult forms; and it has been my better luck not to
have sustained a single loss. In explanation of this success, it
may be remarked that our blacks are well fed, clothed, and favored
as to labor, and our wffiite ladies enjoy in an eminent degree, all
those luxuries and advantages which conspire to health ; they are
therefore stout, well formed, and energetic, having seldom any of
those pelvic deformities or other causes, which induce laborious
or tedious labor ; consequently they conceive readily, and bring
forth with marked facility. It is true, that we sometimes meet
with difficult and fatal labors among both colors, but they are
usually dependent upon too early marriages, accidents, or other
causes beyond the ken of human comprehension or judgment. Such
cases will occur among all classes and colors, and in any community.
It will be seen by reference to these tables, that puerperal convul-
sions are quite rare, at least in this section of Georgia, and I ap-
prehend that what is common here is true of other parts of the State.
An interesting enquiry presents itself in reference to this point,
should it be farther corroborated :—What is the cause of this immu-
nity ? Hypothetical disquisition is not the object of this paper,
but I would make a suggestive rationale of the causation of this
exemption, without fully endorsing or denying its validity—
that it is dependent upon a preponderance of the cerebral over
the spinal system. This is a fruitful and speculative theme,
involving many points of acquiescence and contrariety, but
I am inclined to think many sound views may be urged in justifica-
tion of the position, whether the postulate be correct or not. But
I will reserve these views for another occasion, and descend to a
tabular statement of my cases, appending such remarks as I may
deem necessary.
Eutocia.
Natural { vertex presentations,
’	( 5 twin cases,
( 3 footlings,
Unnatural, < 4 breech,
( 1 facial.
"3 cases arm and shoulder presentation,
1	case arm, foot and placenta,
2	cases placenta previa,
1	case side and funis presenting,
4 cases puerperal convulsions,
7. , , fl case tumor impeding labor,
Complicated, < n i v i	&
7	’ 1 case labial effusion,
2	cases haemorrhage prior to labor,
1 case adherent placenta,
3	cases hour glass contraction,
1 case cord torn from placenta in utero,
^1 case impacted head.
Dystocia.
Manual,—3 cases required turning.
T , .j (2 cases required forceps,
Instrumental, K	\	r ’
’	( 5 cases embryotomy.
The above table is unavoidably incomplete ; in the early part ot
my professional career, I carefully recorded all my difficult obstet-
rical cases, leaving the simple labors to fare for themselves ; hence
the reader will find an aggregate of 473 cases only,when, in reality,
I am confident I have attended six hundred or more. This table
exhibits all my recorded cases of every description, ranging from
the seventh to the ninth month. Itwill be seen that I have trans-
cended some obstetricians in the comparative frequency of some
forms of difficult labor, but this may find an explanation, (at least
in some degree,) in the fact alluded to above, that all the difficult
labors are recorded, while the simple list is not replete. But amid
all this freak of negligence and confusion, I have prepared a tabu-
lar numerical and per centage view of my experience, which I am
inclined to think will successfully compare with results of some
older tokologists, who have a larger experience, and more reputa-
tion than myself. If I am correct in this opinion I trust itwill
give an impetus to Southern Obstetric Medicine, and bring to light
many facts of tokological importance, hitherto thrown aside as
worthless and unimportant. If this desideratum should be attained,
my highest hopes and expectations will be fully consummated.
For the sake of convenience, and the better understanding of
the tabular statement, I have arranged the various classes and spe-
cies of labor in aggregate and distinctive forms.
Aggregate view, No. 1.
Frequency. Percent.
Natural Labor,	.	.	.	5	cases	twins,	1	in	94,* or J.05
Unnatural Labor,	-	-	-	8	cases,	1	in	59, or 1.69
Complex Labor,	-	-	-	21	cases,	1	in	22, or	4.45
Manual Labor, -	3 cases, 1 in 157, or 0.63
Instrument. Labor -	-	-	7 cases, 1 in 67, or 1.06
*A general average with Clarke, Boivin and Baudelocque.
Distinctive view, No. 2.
Eutocia.
Presentations.	No.	Numerical frequency-
Vertex,f......................... 429	429 in 473
Feet,f..............................3	1 in 157
Breech,	-..........................4	lin 118
Face,	......	1	1 in 473
fTwin cases not included.
Dystocia.
Presentation, etc.	No. of cases. Frequency.
f Arm and shoulder, -	-	3	1 in 157
Arm, foot and placenta,	1	1 in 473
Placenta previa, > -	-	2	1 in 236
Side and funis,	?	-	-	1	1	in	473
Convulsions,	-	-	-	4	1	in	118
n r t > Tumor,	1	1 in 473
Complicated, &c. Labial effusion,	_	_	_	b	1	in	473
Hemorrhage,	-	-	-	2	1	in	236
Adherent placenta,	-	-	1	1	in	473
Hour glass contraction, -	3	1 in 157
Cord torn from placenta in utero, 1	1 in 473
Impacted head,	-	-	-	1	1 in 473
Manual,—Cases required version,	-	-	-	3	1 in 157
r ,	, , ') Forceps,	-	-	-	2	1 in 236
ns rumen a , j- j^eqUire(j embryotomy or cephalotomy, 5	1 in 94
From the aggregate view No. 1, it will be seen that twin cases
occur here in the ratio of 1 in 94, or 1.05 per cent. Unnatural
labor, including face, feet, and breech presentations occur in
the ratio of 1 in 59, or 1.69 per cent. Complex labor, including
all mal-positions, accidental or unforeseen deviations, occur 1 in
22, or 4.45 per cent. Manual labor, including turning only,
occurs 1 in 157, or 0.63 per cent., and instrumental labor, inclu-
dingforceps, embryotomy and cephalotomy, 1 in 67, or 1.06 per
cent. It will be remembered that the list of simple eutocia is not
replete; but let us contrast this picture with other authorities, and
see how the case stands; and here, permit me to remark, the
comparison is instituted with no invidious design, but merely to
illustrate the position, and define the standard, as far as compati-
ble, of Southern obstetricy.
Tabular view of relative frequency of various forms of Labor in French
and English Practice.
Presentation, &c. Baudelocque. Boivin. Bland.* Collins. Merriman.
Feet,	1 in 81 Uncertain 1 in 105	1 in 131	1 in 76
Breech,	1	in 59	11	1 in 52	1	in 40	1 in 00
Face,	1	in 296	“	Not known	1	in 504	Not rep
Arm& shoulder,	1 in 336	“	1 in 210	1	in 416	1 in 155
Placental,	Not rep.	“	Not rep.	1	in 1514	Not rep.
Convulsions,	11	u	fl in 210 fl in 693 1 in 105f
Hemmorrhage,	“	il	Uncertain fl in 555 1 in 558f
Twins,	1 in 91	1 in 132 Not rep. 1 in 69	1 in 76
Delivered by art, 1 in 76 Not rep. a Not rep. Not rep.
•Bland says 1 in 44 of his cases were difficult.
j These are transposed by oversight, and should be read so through the whole.
By a brief recapitulation of the preceding tables, it will be
seen that the following facts are demonstrated :	1. That we do
not have unnatural labors as frequently as the French and English,
as far as our tables are capable of determining. 2d. That arm
presentations have occurred more frequently to me, than to Baude-
locque, Bland, or Collins. 3d. That puerperal convulsions have
occurred oftener with me than with Collins or Merriman, although I
have previously declared that our ladies enjoy almost an immunity,
and attempted to account for it; this unique position will find
some atonement by recurring to Dr. Bland’s experience in 1897
cases ; and it will be fully explained in an annotation at another
place. 4th. It will be seen that a lamentable deficiency exists in
the tables of Boivin and Baudelocque, involving points of the high-
est practical and statistical magnitude. 5th. The mortality among
the French women will strike forcibly the most casual observer,
when it is remembered that the forceps are seldom used, and the
perforation sacrilegiously interdicted.
But toplace our own practice and that of others in their proper
light, before the profession, it is necessary that we resort to
another tabular history, showing the precise relative frequency of
mortality and instrumental labor. By this table w7e are willing to
be governed, and to award to every man his just position in obstetri-
cal practice.
Table, of Mortality and Instrumental Labor.
Accoucheurs.	Mortality.	Instrumental.	No. of cases.
Author,	None, .	,	1 in 67	473
Baudelocque,	1 in 24	Uncertain	17,308
Boivin,	No report	1	in	183	20,517
Merriman,	1 in 210	1	in	98	2,947
Bland,	*	1 in 274	1 in 158	1,897
Collins,	1 in 156	1	in	114	16,654
Ritgen,	No report	1	in	9	103
Kluge,	“	1	in	15	1,111
Carus,	“	1	in	13	2,549
Minden,	ie	1	in	12	295
Andree,	“	1	in	35	356
Kustner,	11	1	in	36	368
Boer,	“	1	in	96	9,589
Cusack,	“	1	in	34	1,268
Granville,	11	1	in	80	640
Seibold,	“	1	in	9	340
Voigtel,	“	1	in	5	29
Naegele,	“	1	in	28	1,711
Clarke,	“	1	in	162	10,199
The foregoing table exemplifies a remarkable exemption from
mortality among lying-in women in this country, and we opine
we hazard nothing in saying, that death in child-bed is an event of
uncommon occurrence in Georgia. That some die, it would be
folly to deny; deaths occur in every land, and in all circumstances
and conditions of life. The facts in reference to instrumental labor
are not so favorable as we could wish, but they can be plausibly
and easily explained. 1st. The forceps cases, which are two, oc-
curred both in the same woman, for a lateral pelvic deformity.
This cause will continue to exist, and render her amenable to forceps
deliveries at every lying-in term. This was irretrievable, and
would have occurred to Collins, Baudelocque, Clarke, Boivin or
any one else. 2d. The embryotomy and cephalotomy cases super-
vened under the following circumstances: 1st case. This was a
case of impacted head, occurring with a young negress set. 14 ; the
head was firmly and immovably fixed between the sacrum and
pubis ; the patient had been in labor many hours, and was rapidly
sinking; the child being probably dead, as no pulsation could be de-
tected, I performed cephalotomy; the negress did well, but has
never conceived since. Case 2d was a case of arm and shoulder
presentation. The woman was a delicate female aet. 38; she was at-
tacked with hemorrhage preceding labor on the day prior to my
being called; she was under the care of a midwife. I found the
arm and shoulder presenting, with a prolapsus of the funis ; the
throes were violent, and the patient quite exhausted ; an attempt
at turning was made and abandoned, owing to the death of the
child, and the risk incurred of rupturing the uterus. At the sug-
gestion of Dr. Dill, embryotomy was performed; the patient did
well. Cases 3d and 4th both occurred in the same individual, and
were dependent upon the same causes,—pelvic narrowness later-
ally, and uterine inertia. This woman will never give birth to a
living child of anything like ordinary dimensions. Every effort
was made by myself and others, to rescue these foetuses from the
knife, but without avail: an imperative necessity, essential to the
life of the mother, alone induced the operations. Cephalotomy is
a painful resort, rendered doubly so where we have any reason to
think the child is living, and should never be performed only from
the most urgent necessity, and that, too, after due counsel with
other practitioners. It is painful enough to perform such an ope-
ration, when there is reason to believe the foetus dead, and I
do not envy the feelings or reputation of any man who will
plunge his knife into the brain of an innocent babe in utero,
without sufficient cause, and after mature, calm and deliberate re-
flection, in conference with his brethren ; yet there are those, who
have but little patience, and are anxious to have the opportunity
of securing an operative reputation, who will operate without just
or sufficient grounds. Happily for women and children, their
number is diminutive. It is probable these cases might have been
remedied by a resort to the Cesarian operation. An important
obstetrical question arises here, as to the validity of that opera-
tion. By the Cesarian operation, a risk is incurred of losing
both mother and child, while by cephalotomy, only one is sacri-
ficed. This is an important item, involving a great moral responsi-
bility. It is the rule in English and American practice to sacri-
fice the life of the child ; in this I fully concur, for reasons which
are self evident, and founded upon moral and professional princi-
ples. In no event could I be induced to run the risk of sacrificing
the life of a mother to save an infant, who in reality has no ex-
istence in the external world, but who, whatever may be its fate,
must find a resting place in the bosom of the God who gave it.
The 5th case was induced by a disproportionate head. This
was one of those unavoidable cases which cannot be
remedied by manual interference ; in consultation, it was
resolved to operate, as the only means of saving the mother. This
woman had ever had laborious and difficult labor; she was not
capacious in her pelvic developements; the proportions of the
child were very large; in no event could it have passed the
pelvic straits without a diminished head. This closes an account
of my cases of instrumental labor. Of the reasons which induced
me to operate I shall not speak more definitely than I have, but
leave the reader to his own conclusions, w’ith the simple remark,
“ that men are fallible, and often differ in their views of right
and propriety.”
Turning.—Version in obstetrics is one of those operations which
it is easier to talk about than perform. The young obstetrician,
who has listened to the declamations of a learned Professor for
three or four winters upon the science of midwifery, will find him-
self quite chagrined at the first introduction he has to a case of
several hours standing, requiring turning ; ten to one, unless he has
great manual dexterity, mixed with a good degree of self-posses-
sion and confidence, he will fail. Turning is usually performed by
bringing down the feet, but it may be done by the head. In what-
ever way it is performed, the operator must exercise great
caution and care ; he must be patient, and remember he is not
feeling in a barrel, or turning a log of wood about; the least
error or undue force, may cost him his reputation for life. I have
never performed the operation of version except in arm and side pre-
sentations ; in one instance the child was saved, the others were lost.
I have usually, where the uterus was violently contracted, ad-
ministered a full dose of opium before commencing the operation;
and after its completion, if the pains were inefficient, I have
ordered an infusion of ergot invariably, with the effect of having
my anticipations fully realized. It is not the province of this com-
munication to give general directions for the performing of these
operations; indeed they can only be learned by careful expeiience
in clinical instruction ; I will therefore proceed.
Convulsions.—Probably no part of obstetrics is attended with
more thrilling interest and intense anxiety than convulsive dysto-
cia. Fortunately, as I have previously remarked, this form of la-
bor seldom occurs among us. The four cases which came under
my care, were in three instances in the same person, and of the
epileptic variety. The lady is set. 35 ; she has had seven births.
With her first and every subsequent child she has had puerperal
convulsions; she is very subject to premature labor, which
is always announced by a convulsion. The convulsions
cease as soon as delivery ensues, but prior to that, they
resist every therapeutic application for their suspension. I have
seen them adopt a strictly tertian type with her, and be partially
controlled by quinine; they invariably continue to, and through
labor ; and I never saw her have one after.
The last attack was in August, ’49. I delivered her then of a
foetus at 6 months and 22 days ; it is now living, and is a stout,
fat child. After these attacks, she has speedy gettings up, and
has a return of fine health until her next pregnancy.
The 4th case was a stout, athletic woman, with her first child ;
the convulsions are of an apoplectic order, unquestionably promoted
by an overloaded stomach. This case yielded to copious venesec-
tion, active catharsis, and delivery. As a general rule, not invaria-
ble, however, the convulsions cease as soon as the birth of the
child takes place, and the physician should be assiduous in his at-
tentions, or the foetus will be expelled before he is aware of it.
These cases usually excite the mind a great deal, and often de-
range the imagination ; causing many painful emotions. I recol-
lect this last case was attacked on Monday, and after convales-
cence, she experienced a mental horror at the approach of Monday,
and in several instances I was sent for to ward off the attack she
expected on that day. These are the only cases I have seen prior
to parturition, and I know of no physician here who has had a
case, although I have made frequent enquiries. It is a protean
disease, requiring the promptest attention, and the best of skill.
Placenta Previa.—I have met with but two cases of placenta
previa ; in both of these it was attached partially to the os uteri;
they both occurred at the full period. I delivered in both cases
the placenta first, and as the pains were violent, the children in
both were soon expelled. I am induced to believe that the danger
in such cases does not originate from the placental presentation, or
it would cease to exist as soon as it was expelled, but it is derived
from the exposed orifices of the uterine vessels. It is very clear
to my mind that this is correct, from the fact that the placenta is
usually detached in the beginning of labor, consequently the wo-
man could not suffer from placental hemorrhage, as no affinity
exists after that time with her and the child through the placental
circulation. Now it is undeniably correct, that in placental pre-
sentations, the attachment being about the neck of the uterus, the
flooding would be more violent from the exposed orifices, owing
to the violent contractions of the body of the womb, producing an
expulsion of the foetus, and a necessary opening of the os uteri.
This is a plain but truthful process, and to me fully demonstrates
the theory of hemorrhage dependent upon placental presentations.
If you deliver the placenta in these cases, the flooding does not
cease, but if you deliver both child and placenta it will. We pre-
sume no man of any experience will doubt this position ; and
what does it prove? It surely establishes the point I have taken,—
that placental hemorrhages (as they are called,} depend upon an
exposition of the mouths of the uterine vessels, not upon an ad-
herence of the placenta to the os uteri. What then is the practice ?
It is plain, self-evident, and unquestionable; deliver the placenta,
promote uterine contraction, and deliver the foetus as soon as ne-
cessary, and with any means your judgment may dictate.
Hemorrhage.—'Hemorrhage during pregnancy is not an un-
common occurrence. It is often alarming, requiring the most de-
cided means to stay its progress ; when again it is of little impor-
tance, requiring nothing more than quietude and the recumbent
posture to restore the patient. From the 7th to the 9th month, I
have met but two cases ; they were mild in their character, and
demanded nothing unusual. The emergency of such cases always
depends upon the quantity of blood lost and losing, and the abili-
ty of the patient to bear it. The points of practice are always to
be determined in reference to these facts. I have never had a
case of uterine hemorrhage, where I gave ergot prior to delivery.
Hour Glass Contraction.—This is dependent upon a circular con-
traction of the uterus at the point where it exists, and isoften a source
of considerable annoyance to the accoucheur, particularly if called
late. If you are present, the difficulty is usually easily overcome
by a gentle introduction of the hand and fingers into the point of
constriction, and gently extracting the placenta; if a failure
should happen, patience is a fine remedial agent ; should all these
fail, bleed and give opium. I have never had much difficulty in
these cases, but can easily imagine that they can be very annoy-
ing. Always bear in mind gentleness is the hand-maid of skill in
these cases. Some seem predisposed to hour glass contraction.
Adherent Placenta.—This is a perplexing and often difficult
complication in obstetrical practice. An adherent placenta is
really an untoward event. Fortunately for females, it does not very
often exist. Physicians are very frequently called to patients
with the belief that they have adhering placentas ; this is gener-
ally an error of judgment, for in a large majority of cases it is
only a retention of the mass. These conditions are widely differ-
ent and are not to be identified as one in obstetrical practice. Adhe-
sions of the placenta are usually schirrous, cartilaginous, or ossi-
fied, and they are to be extracted with great care and gentleness;
indeed in all manipulations in the inner womb,“&e gentle,” should
be our motto; violence is “death,” The hand should be well oiled,
and easily introduced, when the placenta should be carefully,
cautiously and quietly detached from the uterus. If a portion
should remain and cannot be extracted, it will be decomposed and
come off; in this case we should use tepid antiseptic enemata and
washes daily.
In retention of the placenta, the same caution should be ob-
served. In my own practice I never have a retained placenta. I
invariably deliver in 15 minutes after delivery, all things being
fair. I have never had any cause to regret the practice, but the
experience of every week proves to me its correctness. It is sel-
dom I see a hemorrhage after delivery among my own cases, and I
attribute it to the speedy delivery of the after-birth.
Labor, Duration, Spontaneous Evolution, and anomalous forms.
—Labor is that process by which the child is expelled from the
genitals of the woman ; it has many varieties, as has been seen,
and which it is not necessary to reiterate. Labor may be retard-
ed by several catses, which are laid down in the books ; but one
of the most common causes of retardation in simple eutocia that I
have met with, is the cord being around the neck of the child,
and it is much more difficult to remedy than a tyro would suspect.
Labor is generally accompanied with pain ; but it it not an invaria-
ble attendant. I remember to have seen a negress bring forth a fine
large child, without the least semblance of pain evident to myself or
others; indeed she positively denied having the child until it
was exhibited. The duration of labor is a pleasing and interest-
ing question; it is not settled, and will not probably be for many
obvious reasons. In a country practice many circumstances con-
spire to prevent physicians from keeping a record of facts in
reference to this subject; it is seldom we are called at the com-
mencement of labor, which accounts at once, in a great degree,
for our inability to keep a table ; but in my own practice, as far
as I have been able to observe, the duration of simple labor does
not exceed six hours. The doctrine of spontaneous evolutions in
transverse and brachial presentations, was first taught, we believe,
by Denman; since which time it has been verified in numerous
instances by many accoucheurs ; at the present day it is not a pro-
blem. I met with a single instance of this evolution ; it differed
in no respect from other cases of the kind; the child was dead,
which is usual in all such cases. I should deem it a rare event?
for one to be born alive.
In obstetricy the practitioner will meet with many deviations of
presentation, which are mentioned by authors; in all such be must
be governed by his own superior judgment, and general princi-
ples. I have met a case of twins, where one was born in the
early part of the day, the other was delayed until the next
evening—nearly 36 hours ; in this case I was guided alone by
general principles ; the patient had no pain or flooding—she was
calm and quiet. I waited patiently ; the other child came along
in proper order, was sound and healthy; the woman did well. In
twins, authors tell us, there is a great proclivity to flooding; I
have not found it so; my twin cases do as well, as any others. I
saw a case in which the cord was torn from the placenta in utero;
being present early, I immediately introduced my hand, and brought
away the after birth, which had been retained. These errors are
remedied with facility, when we are present soon after their occur-
rence, and the practitioner has the essential ingredients of a skil-
ful tokologist—self possession and confidence in his ability ; with-
out these, success in every department is equivocal. In two in-
stances labor was impeded by the vulva being effused with serum
and blood. The first was punctured, and the case relieved in due
season ; the second was originally a tumor, it became pulsative
from an injury. I plunged my lancet into it; the dark grumous
and offensive matter it contained was discharged ; the labor was
f
soon after completed by the natural efforts. The other cases
which came under my inspection, merit no special attention, and I
shall not advert to them.
Ergot.—Much has been said in justification and denunciation
of this drug; by one it is represented as dangerous to the child ;
by another it is denounced as producing hour glass contractions;
and by a third it is proscribed for inefficiency. I have used ergot
in almost every form of labor, and I can accord to it none of these
properties. In my hands, it has ever been prompt and efficient;
I never saw any injury from it in any stage of labor. I believe it
excites uterine contractions and promotes dilatation of the os uteri.
I have never had a case of hemorrhage after giving it prior to de-
livery. I believe it almost a specific in those cases where there
is a tendency to flooding; it should be given 20 or 25 minutes be-
fore labor is consummated. The only error it is guilty of, is a pre-
disposition to operate upon the bowels in some women. This can
be modified by giving it in conjunction with a little paregoric.
Pregnancy.—Hippocrates, Galen, Pliny, La Motte, Haller,
Aristotle, Petit, and Levret, contended that pregnancy terminated
at the end of nine calendar months, but might be prolonged to ten
or fifteen. Now I am not sufficiently versed in gestation to defi-
nitively determine this point, but in all the cases I have witnessed
in reference to this question, pregnancy has terminated at about the
39th week, plus one day. The quickening period is about the 4th
month ; five months from this parturition will usually take place.
I think the period of gestation is subject to slight changes ; it may
be a few days over 39 weeks, or a few under it. There is great
discrepancy among women in reckoning, and in no instance ought
the count of the patient to be strictly relied upon, unless it be with
a lady remarkable for her exactness and perception in such things.
I remember the case of a lady who brought forth precisely 39 weeks
and 2 days from the day of her marriage. I know another instance
in which the woman was confined precisely 39 weeks, one day,
from the return of her husband who had been gone for four months.
While on the subject of pregnancy, I will remark, that I am in-
clined to believe in the hereditary influence of labor so far as
quickness, or tediousness of the process is concerned In a large
majority of cases, I have found where women had quick labors,
their mothers before them had also, and vice versa. Now I will not
assert the rule as invariable, but it is very apt to be the case.
I have now gone through what I fully intended when I began—
a synoptical account of my obstetrical experience. I have extended
the paper much farther than I at first intended to do. I hope,
however, its unforeseen prolixity will not be at all detrimental. It
is possible in some parts of its serpentine course, I may have
committed some errors, if so, they are unintentional and wdll be
pleasurably rectified. I have not thought proper to pursue a strictly
systematic course in treating of the various topics involved, for the
reason thatthe paper was intended as apractical effort,with no di-
dactic intention, but only as my own experience. In conclusion, I
will make a small tabular view of facts and observations in refer-
ence to genera] items.
Miscellaneous Table.
Duration of labor, 6 hours.
Duration of pregnancy, 39 weeks, 1 day.
1 Case spontaneous evolution.
1 Case 36 hours between births.
1 Case without pain in labor.
1 Case child with teeth.
1 Case imperforate anus.
1	Case hydatids, (not mentioned in tables.')
4 Cases still born, restored.
2	Forceps cases, both children living.
In a majority of all the cases, males predominated to a small extent.