OBSTETRICS.
Extraordinary Case of Mortification, occasioned by Pregnancy. By
Samuel L. Hamilton. M. D.,of Chattooga county, Georgia.—Mrs. S.,
aged twenty years, during the sixth month of her second pregnancy,
was attacked June 5th, 1848, with remittent fever, which readily
yielded to ordinary treatment. After this she did well for twelve or
fifteen days, during which time nothing of importance occurred, but she
was perhaps unusually hearty, which I attributed to her condition.
On the morning of the 20th of June I was again called to see her,
and found her with extreme pain in the toes of her right limb, which
was so cold half way to the knee as to yield to the hand when applied
thp same sensation as that of a dead body. There was little or no ex-
citement of the pulse; nor was there any evidence of disease in the
general system. The pain in the foot increased from day to day, until
the cries and shrieks of the unfortunate sufferer were almost too intole-
rable to be borne by her surrounding friends. It cannot be said that
she was entirely easy until her delivery, except while under the influ-
ence of large doses of morphine, from the effects of which she would fre-
quently awake in violent pain. Her sleep was evidently not profound, under
as large doses of the above medicine as it is thought prudent to admin-
ister under any circumstances. It was attempted, but in vain, to restore
the lost temperature of the extremity—every thing was used that would
promise this result, without vesicating the skin, which was avoided,
notwithstanding the repeated solicitation of friends for the application
of a fly-blister. There finally appeared large yellow blisters upon the
diseased surface, which, on being ruptured, discharged a serous fluid. It
was evident, after this, that there was not sufficient vitality in the skin
to warrant recovery. The skin and all the soft tissues now began to
slough, until the ligaments of the metatarsal articulations were de-
stroyed—at this point they were separated, which gave the patient some
slight relief. The' temperature of the limb was partially restored from
above, down to within a short distance of the ankle-joint; the pain,
however, continued unabated till labor came on, when it then entirely
ceased. The lady was then delivered of a large child, after which there
was not the slightest return of pain. The labor was in all respects
natural—the stump of the extremity, which had been suppurating, now
readily healed—the woman recovered, and has since given birth to two
children, without the slightest return of the affection.
I was constrained to the opinion that this extraordinary case was the
result of pressure of the gravid uterus upon the arteries and nerves
passing through the pelvis—viz., the ext. iliac artery and the great
sciatic nerve, whose extremities supply nutrition and innervation to the
disorganized part. From the history of her previous pregnancy, it ap-
peared that there had been running ulcers from about the sixth month
until delivery ; the cicatrices were still perceptible, and occupied the
regions covering the posterior and antciior tibial arteries. I think it a
reasonable inference, that the pressure was exerted upon the nerves, as
well as the arteries, from the intense and continuous pain which nothing
could relieve until the removal of the cause, when the suffering simul-
taneously disappeared.
As to the treatment of the case, opium may have given some tempo-
rary relief. Position was tried without the least success. ■ Supporters
were also tried with the same result. We would feel inclined, however,
were we called to treat another case, to try more thoroughly both sup-
porters and position. We might particularize as to local applications,
&c., but they were such as common sense would dictate, and failed to
afford any relief—we therefore omit their tedious detail.—Southern
Med. and Surg. Journ.