Further observations on chloroform in the practice of midwifery / by Edward W. Murphy.

Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Further observations on chloroform in the practice of midwifery / by Edward W. Murphy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    os uteri was dilated. After this, the action of the uterus continued with in- creased force, powerful pains returning every five minutes until ten o’clock a.m.; the head was found still above the brim, having the funis before it; the pulsa- tions had ceased ; the membranes were unbroken. Finding that the child had died,and that the disproportion was too great to admit, the head within the pelvis, I determined to perforate, and thus to deliver her. In this case also I requested Dr Snow’s assistance, who kindly undertook the management of etherization. The patient inhaled a little Dutch liquid for the first two minutes, but owing to the limited supply of it, and a fault in the inhaler, she was not rendered quite insensible by it; chloroform was then used, and she was soon rendered first unconscious, then insensible. There were occasional contractions of the uterus and expulsive efforts during the operation ; chiefly, at those times when the patient was less under the influence of the chloroform, when inhalation was intermitted. The head was perforated, the brain evacuated, and the crotchet applied. The difficulty of extraction was found to be very great. The crotchet and craniotomy forceps were used alternately, the broken bones of the cranium removed by them, the head itself brought into the brim, but there it remained fixed for some time; at length, after repeated efforts, it began to advance; and when it descended into the cavity of the pelvis, the delivery was soon com- pleted. Some delay, however, was caused by the shoulders. The operation lasted thirty-five minutes, and she was completely under the influence of chloroform for about three quarters of an hour. Six fluid drachms of chloro- form were used. After delivery, the uterus contracted strongly, and expelled the placenta in about ten minutes; not the slightest appearance of hemorrhage was observed. When consciousness returned, she expressed great surprise at her delivery; soon after she was seized with vomiting, that continued at intervals through the day. 13th.—.She has passed an excellent night; pulse 84 ; has had no vomiting nor nausea; passes urine freely ; there is no tenderness of the abdomen. She only complains of slight after-pains, and some smarting in the vagina. From this date, there was no change in the favourable progress of her recovery. ] Qth.—She feels so well that she wishes to get up. Of course, this was not permitted, but nothing occurred subsequently worthy of notice. Case XII.—Premature Labour at Seven and a-half Months ; Arm presenting ; Child turned ; Chloroform ; Great Constitutional Debility. M. P., aged twenty-one, a delicate looking woman, had received a letter from University College Hospital for attendance during her confinement. She had lived in London about five months; before that, she resided in the country. She had been in the enjoyment of every comfort until she was sixteen, when she lost her mother, who died insane in an asylum. Her father also died shortly after. She was thus left an orphan. When eighteen, she married, and since that time had to struggle with poverty. She was twice pregnant previous to her present confinement ; and, in both instances, miscarried at the sixth month. She says they were “ cross births,” and that she never afterwards recovered her strength, which she attributed to the want of the proper diet to which she had been formerly accustomed. . January 12th, 1849.—Her labour pains came on at the seventh month, in- duced, perhaps, by additional trials. Her husband was too ill to work, which restricted still more their limited resources, and about three weeks previously her sister, whom she closely attended, died of erysipelas. This caused her gic&t mental anxiety and depression; at length irregular uterine pains came on, which lasted for four days, but never amounted to regular labour pains. On the night of the fifteenth, however, one strong pain came on that ruptured the mem- branes; they then ceased. . „ c a ri a January lGth.—Mr Beales, a very intelligent pupil, saw her. He found the os uteri very slightly dilated ; there was some hemorrhage, which he arrested, and remained three hours with her. During this time she had no further
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