neral improvement she has enjoyed some hours of refreshing sleep, there is every prospect, not only of returning health but also of reason. A mere gleam of returning reason without a corresponding improvement of health will afford but little satisfaction to the mind of a discerning practitioner, for it gives no assurance that the danger of fatal sinking is at all diminished. Disordered mind coming on some weeks after delivery from the effects of over-nursing, when the patient has been unable to afford the necessary supply to her child, is seldom attended with so much danger to life as where suddenly induced immediately after labour by hæmorrhage: the intermediate stage between reason and derangement is more distinctly marked, and is of considerable duration; and the gradually increasing affection of the mind frequently warns even the patient herself to seek medical advice before the symptoms become more serious. We believe that the proportion of patients in whom the mind continues deranged after their health has been restored is very small, and feel convinced that the results afforded by the practice of lunatic hospitals are far from giving a correct estimate. A large majority of the cases of derangement in lying-in women are of such short duration that they never come even under the notice of those members of the profession whose attention is particularly devoted to this branch of medical practice, still less do they require to be removed into asylums for lunatics. "The records of hospitals contain an account of cases which have been admitted only because they were unusually permanent; they are the picked obstinate cases, and can afford no notion of the average duration of the cases of all kinds; the cases of short duration, which last only a few days or a few weeks, which form a large proportion, are totally lost in the estimate of a lunatic hospital." (Gooch, op. cit. p. 125.) The results of Dr. Gooch's practice, which is known to have been very extensive, and especially in consultation, shows that out of a considerable number of cases only two of his patients remained disordered in mind," and of these one had already been so before her marriage." There are two classes of patients in whom disordered mind is not only much to be apprehended during their lying-in, but in whom there will be some reason to fear that it may become permanent; first, in those who have already been deranged independent of the puerperal state, or who inherit a strong predisposition to mental disease; and secondly, in those where hysteria has existed in an unusual degree during the latter part of pregnancy. These circumstances justify us in using every precaution in their lying-in to avoid any thing which may excite the disease; but, as already stated, not only is the disorder of the mind rarely of any duration, but it is seldom known to recur on any subsequent occasion. Treatment. Our indications of treatment are twofold, viz. to rouse and support the powers of the patient, and to allay as far as possible the irritability of the brain and nervous system. If the patient has been prostrated by hæmorrhage, not only a nutritious but even a cordial and stimulant diet will be necessary: the emulsion of egg and brandy, which we have before recommended in anæmic puerperal convulsions, will here prove very useful; and it must be given in small but frequently repeated doses, until an improvement is observed in the pulse and in her general appearance. Under all circumstances it will scarcely ever be proper or even safe to confine her to low diet: beef-tea, veal-broth, &c. should be given in considerable quantities during the twenty-four hours; and it is surprising what improvement will even take place merely from the administration of this bland nutriment. If the face be pale and the pulse low, wine may be given according to the circumstances of the case. To calm the cerebral excitement and procure sleep, sedatives will prove of the greatest value, and require to be repeated until the nervous system is fairly under their influence. The intense pain at the vertex, which of itself is sometimes quite sufficient to produce delirium, the tinnitus aurium, &c. all cease; the pulse becomes softer, fuller, and slower; and, even if sleep be not immediately induced, a state of calm tranquillity follows, in which the mind becomes more composed. The Liquor Opii Sedativus may be given in a dose of twentyfive minims, and repeated in an hour or so according to circumstances. The combination of camphor with morphia, or extract of henbane, is an excellent form, and may be given with perfect safety to a considerable extent. The bowels should be opened by the mildest laxatives, such as castor oil, rhubarb and manna, &c. medicines which will neither act violently, nor weaken by producing watery evacuations; and, once in every few days, it will be desirable to rouse the action of the liver by Hydrarg. c. Cretâ, with extract of hop or gentian. To assist still further in restoring her health and strength, she should take an infusion of a vegetable bitter with a mineral acid. As soon as her strength will permit, a change of residence may be recommended, and she should remove to some quiet watering-place, where invigorating air and agreeable scenery and occupations will assist in completing her recovery. "The constant attendants on the patient ought to be those who will controul her effectually but mildly, who will not irritate her, and will protect her from self-injury. These tasks are seldom well performed by her own servants and relatives. "If the disease lasts more than a few days, and threatens to be of considerable duration, her monthly nurse and own servants ought to be removed, and a nurse accustomed to the care of deranged persons placed in their stead. Such an attendant will have more controul over the patient, and be more likely to protect her from self-injury." "With regard to the removal of her husband and relations, this also will be a question; if the disease threatens to be lasting, it is generally right. Interviews with relations and friends are commonly passed in increased emotion, remonstrance, altercation, and obviously do harm: large experience also is decidedly favourable to separation as a general rule; yet there may be exceptions, which the intelligent practitioner will detect by observing the effect of intercourse." (Gooch, op. cit. p. 158.) Age, rigidity of the passages from, obstructing labour, 199. Influence of, on the contractile power of Allantoidis Liquor, situation of the, 29. Its existence in the human embryo, 40. Amnii Liquor spurius, situation of the, 29. Use of the, 30. Formation of the bag of the, 100. Amnion, description of the, 29. Formation of the, 39. Dropsy of the, 181. Anatomy of utero-gestation, 2. Of the pelvis, 2. Of the sacrum, 3. Of the coccyx, 3. Of the ovaria, 7. Of the Fallopian tubes, 11. Of the uterus, 12. Comparative, of the, 15 Of the external organs of generation in Anamic puerperal convulsions, 245. Anteversion of the uterus, 196. Arm, presentation of the, 172. See La- bour. With the head, 173. See Presentation. Atony of the uterus, 205. Debility, 206. Derangement of the digestive organs, Mental affections, 206. Age and temperament, 207. Rheumatism of the gravid uterus, Inflammation of the uterus, 208. Treatment of, 208. 215. Auscultation in the diagnosis of pregnancy, 53. Uterine souffle, 53. Funic souffle, 55. Mode of ascertaining twin pregnancy by means of, 60. During the pains, 97. Ares of the pelvis, 6. Ballottement, method of performing, 56. labour, 204. Stone in the, 204. Blastodermic Membrane, 36. See Egg. Their connection with the placenta, 31. pregnancy, 51. Abscess of the, 119. Breech, presentation of the, 131. See Nates.. Cæsarian Operation, 153-176. Indications for its performance, 153. Canalis venosus, situation of the, 46. Chest, morbid depositions in the foetal, ob- Child, size of, at birth, 178. Its influence on the duration of labour, Unnatural form of the, 178. See Fœtus. Changes which it undergoes during preg- Cicatrices in the vagina obstructing labour, 200. Contractile power of the uterus, derangement Dystocia, divisions and species of, continued:- Abnormal state of the pelvis, 184. 195. Faulty condition of the expelling Inversion of the uterus, 218. Precipitate labour, 228. Prolapsus of the umbilical cord, 232. Puerperal convulsions, 237. Placenta prævia, 248. Puerperal fevers, 263. Dystocia epileptica, 241. See Convulsions, Presentation of the, 173. See Presenta- Female Pelvis, distinction between it and the Organs of generation described, 7. Fever, milk, 119: See Milk Fever. Puerperal, 263. See Puerperal Fever Treatment of, 62. Flooding. See Hæmorrhage. Fœtus, characters of a full-grown, 43. Nutrition of the, 44. Circulation in the, 45. Changes which it undergoes at the Signs of the death of the, 64. Premature expulsion of the, 86. See Abor- Size and form of the, at birth, 178. Morbid depositions in the cavities of the, Anchylosis of the joints of the, 180. Varieties of the, 136. General indications for their use, 139. Formative Organs, 7. Fracture of the parietal bone of the foetus Funic Souffle. See Auscultation. Gastro-bilious puerperal fever, 283. See Puer- Gastrotomy. See Cæsarian Operation. Germinal Vesicle. See Egg. Graafian Vesicles, description of the, 8. Hæmorrhage, uterine, after the birth of the Labia, anatomical description of the, 24. Varicose and oedematous swellings of the, Labour, premature. See Premature Expulsion of the Fœtus. Natural, 95. Preparatory stage of, 96. First contractions, 96. Action of the pains, 97. 97. Show, 100. Duration of the first stage, 100. Straining pains, 101. Dilatation of the perineum, 102. Third stage of, 103. Expulsion of the placenta, 103. Treatment of, 104. State of the bowels, 105. Management of the first stage, Examination of the patient, 108. Cord round the child's neck, Ligature of the cord, 115. Milk fever and abscess, 119. Diet during lactation, 121. Mechanism of, 124. See Parturition. Precipitate, 228. See Precipitate La- bour. rition. Membrana decidua, 25. See Decidua Mem- Membrane, blastodermic, 36. Membranes, formation of the, 25. Premature rupture of the, 181. Menses, cessation of the, in pregnancy, 49. Auscultation during the pains, Midwifery, explanation of the term, 1. Operations of, 135. |