CONTENT S.

PART IV.

PATHOLOGY OF THE PUERPERAL STATE.

Analogy between Puerperal and Surgical Fever,

Communicability and Propagation of Puerperal Fever,

Pathological Researches on Puerperal Arterial Obstruction and Inflammation, .

Tetanus following Lesions of the Uterus, Abortion, and Parturition,

Fatty Degeneration of the Muscular Structure of the Uterus after Delivery,

Perineal Fistula, left by the transit of the Infant through the Perineum,

Collodion as an application to Sore Nipples,

PART V.

PHYSIOLOGY AND PATHOLOGY OF THE PRODUCTS

OF CONCEPTION.

PAGE

17

33

46

59

83

84

87

Attitude and Positions, Natural and Preternatural, of the Foetus in Utero,

Excitation of the Foetal Movements by Cold,

88

147

Vital Contractions in the Umbilical Arteries and Veins,

Peritonitis in the Foetus in Utero,

148

150

Inflammatory Origin of some Malformations in other parts of the Body,

Case of Peritonitis, with permanence of the Omphalo-Mesenteric Vessels,

Birth of a Double Monster; one child alive,

Spontaneous Amputation of the Limbs of the Foetus in Utero,

Rudimentary Reproduction of Extremities after their Spontaneous Amputation,

Placental Phthisis or Apnoea, as an Intra-Uterine cause of Death among Pre-

mature Children; its varieties and treatment,

Propositions regarding Local Paralysis occurring during Infancy,

On the Pathological Connection between Chorea and Rheumatism,

Chloroform in Infantile Convulsions, and other Spasmodic Diseases, and in

Pneumonia, .

424

426

428

Simultaneous coexistence and progress of Small-Pox and Cow-Pox; their mutual

influence on each other,

433

On the results of Vaccination, and the possible prophylaxis, etc., of Scarlatina,

Measles, and other Diseases,

436

External Use of Oil, in the Prevention and Treatment of Scrofula, Phthisis, etc.,

441

PART VII.

ANESTHESIA.

attendant upon Surgical Operations,

CHAP. I. Mere Opinions and Prejudgments not sufficient to settle the question

of the propriety or impropriety of Anesthetic Agents; illustration

from the History of Vaccination,

CHAP. III. Conditions for insuring successful Anæsthesia,

463

CHAP. II. Proof of Anæsthetic Agents possessing the power of annulling pain

CHAP. IV. The Prevention of Pain in Surgical Operations alleged to be unneces-

sary and improper,

476

CHAP. V. Value and necessity of the Numerical Method of Investigation as ap-

plied to Surgery,

486

CHAP. VI. Does Anæsthesia increase or decrease the Mortality attendant upon

Surgical Operations?

507

SECTION II.

ANESTHESIA IN MIDWIFERY.

CHAP. I. On the Inhalation of Sulphuric Ether in the Practice of Midwifery, . 521

CHAP. II. Superinduction of Anæsthesia in Natural and Morbid Parturition:

with cases illustrative of the Use and Effects of Chloroform in

Obstetric Practice,

CHAP. III. Answer to the Religious Objections advanced against the employment

of Anæsthetic Agents in Midwifery and Surgery,.

CHAP. IV. Same subject continued, in a Letter to Dr. Protheroe Smith of London,

CHAP. V. On the early History and Progress of Anaesthetic Midwifery,

CHAP. VI. Results of the Practice of Anæsthesia in Midwifery,

CHAP. VII. Mode of exhibiting Chloroform; Dose, etc.,

CHAP. VIII. Report of the Results of Anesthesia from different Obstetric Hos-

pitals and Practitioners,

CHAP. IX. Alleged difficulties in the Superinduction of Anesthesia,

CHAP. X. Objections to Anæsthesia in Midwifery,

CHAP. XI. Answer to the Objections to Anesthesia in Midwifery, adduced by

Professor Meigs of Philadelphia, .

CHAP. XII. Reply to other Minor Objections to Anæsthesia in Midwifery,

CHAP. XIII. Remarks on the occasional Fatal Result of the administration of

Chloroform,

PAGE

559

568

573

580

585

613

615

621

640

643

SECTION III.

ON THE NATURE AND POWERS OF VARIOUS ANESTHETIC AGENTS.

CHAP. I. Account of a New Anæsthetic Agent as a Substitute for Sulphuric

Ether in Surgery and Midwifery,

647

CHAP. II. Anæsthetic and other Therapeutic Properties of Chloroform,

CHAP. III. Notes on the Anæsthetic effects of Chloride of Hydrocarbon, Nitrate

of Ethyle, Benzin, Aldehyde, and Bisulphuret of Carbon,

656

662

SECTION IV.

ON LOCAL ANESTHESIA.

CHAP. I. Historical Notice on the Production of Artificial Local Anaesthesia,

CHAP. II. On the Production of Local Anæsthesia in the Lower Animals,

CHAP. III. The Production of Local Anæsthesia in the Human Subject,

667

669

672

On the Practical Application of Chloroform as a Topical Anæsthetic

to Mucous and Cutaneous Surfaces,

680

On Carbonic Acid Gas as a Local Anæsthetic in Uterine Diseases,

&c.,

687

Summary regarding the Therapeutic History and Effects of Chloro-

form-History of Anaesthetics,

695

Anæsthetics in Surgery; from a Patient's point of view,

711

APPENDIX.

Note to page 268. The American case of alleged Double Hermaphroditism,

PART IV.

PATHOLOGY OF THE PUERPERAL STATE.

ON THE ANALOGY BETWEEN PUERPERAL
AND SURGICAL FEVER.

(From Edinburgh Monthly Journal of Medical Science, November, 1850, p. 414.)

NEARLY 3000 mothers die in childbed every year in England and Wales. Among these 3000 deaths, a comparatively small proportion only are the direct result of convulsions, hemorrhage, rupture of the uterus, and the other more immediate or primary complications and accidents connected with parturition. The great majority of these maternal deaths is produced by puerperal fever. Dr. Ferguson believes that as many as seven-eighths of the total mortality in childbirth are owing to puerperal fever and its modifications. This estimate of its effects is probably too high; but the observations of Farr,3 Kiwisch, and others, have amply shown that puerperal fever, and the visceral inflammations and deposits which are included under that name, are undoubtedly by far the most common causes of death in childbirth. Among 2890 women delivered in the old Edinburgh Lying-in Hospital, from 1823 to 1837, 47 maternal deaths occurred. Of these 47 deaths, 36 were the consequence of puerperal fever; and the remaining 11 were produced by other primary obstetric complications and causes.

Among the individuals who are obliged to become the subjects

According to the Reports of the Registrar-General, the mortality from childbirth in England and Wales was 2811 in 1838, 2915 in 1839, 2989 in 1840, 3007 in 1841, and 2687 in 1842. During these five years, 14,409 English women died in childbirth; or about one in every third hour. Perhaps the returns under this head show even less than the reality, deaths occurring during the puerperal month being too often referred to other causes than childbirth.

2 Essays on the Most Important Diseases of Women, p. 1. 3 Fifth Report of Registrar-General, p. 380.

Brit. and For. Review, vol. xiii. p. 111.