unless the practitioners acquire competent knowledge by some regular medical education: That there is no existing law to prevent persons without any proper medical education practising in all or any of the above branches; and a great number of persons therefore, in every part of the kingdom, assume the character and exercise the functions of the apothecary, surgeon-apothecary, and practitioner in midwifery, who are wholly ignorant and utterly incompetent to the performance of the duties of the profession, whereby the safety and health of the community is endangered, the general character of the profession disgraced and brought into disrepute, and the interests of your petitioners greatly injured: That it is essential to the preservation of the character of the profession, and to the interest of the community at large, that provision should be made for remedying the above evils: That a Bill is pending in Parliament before your Honorable House, entitled "A Bill for regulating the Practice and Profession of Apothecaries, Surgeon-Apothecaries, and Practitioners in Midwifery, throughout England and Wales:" That your petitioners verily believe if the said Bill should be passed into a law, that the evils and inconveniencies complained of by your petitioners will be remedied: Your petitioners therefore humbly pray that the said Bill may be passed into a law, under such regulations and restrictions, and in such manner, as to this Honorable House may seem meet: And your petitioners shall ever pray, &c.* (The Appendix to this Report in our next.) To the Editors of the Medical and Physical Journal. Y * No names can be affixed to the petition by proxy. cases arising from rigid muscular fibre attend strong young women, or those advanced in years with first children. To the symptoms of spasm I can add one more, viz. the child is in frequent motion, or, as the mother describes it, it worries. I hope from this description every práctitioner will be able to discriminate between the two cases. Obstetricus has mistaken my meaning when I said that I supposed opium would have no effect in cases arising from rigid muscular fibre my idea was confined to the relief of the case. Ipswich. I am, Gentlemen, Your obedient Servant, . P.S.-Should Obstetricus have another case of puerperal convulsions, will not opium save his patient better than brandy? I suppose those cases partake much of spasm. For the Medical and Physical Journal. An ACCOUNT of a RUPTURE of the UTERUS during LABOUR. N Thursday the 29th of July last, I was requested to inquire into the cause of death in a poor woman who had died in labour, undelivered, the day preceding. Upon calling at the house of the deceased with the view of making the necessary arrangements, I found the body in a high state of putrefaction, though life had been extinct little more than twenty-four hours. The belly was distended to an astonishing size; the thighs and legs were emphysematous and oedematous; vesications containing a colored fluid had arisen in various parts of the body; the face was swelled, and had become quite black: in short, the dead body exhibited the most disgusting spectacle I ever beheld. 1 In the course of that evening, in the presence of two other medical gentlemen, I examined the body. On making a puncture into the abdominal cavity, a considerable quantity of a most offensive gas escaped, which not only affected the air in the room in a most nauseous manner, but even that of the whole house. Upon dividing the abdominal parietes in the course of the linea alba, the foetus presented itself to view, lying in the cavity of the abdomen, completely out of the uterus, across the brim of the pelvis, with the left side of its head upon the right ilium, with its breech and left thigh upon the left ilium, having its back inclined towards the pubes, and its belly towards the lower part of the spine. On raising the foetus, the placenta was seen lying upon the anterior peritoneal surface of the uterus, which, as well as the child, was was completely expelled out of its cavity; in the pelvis, there was but a small quantity of bloody fluid. The foetus was large in size, and showed evident marks of commencing putrefaction. The uterus was tolerably well contracted; as much so, in the opinion of the gentlemen present, as that organ usually is found a few hours after delivery. making a further inquiry, a large laceration, the extent of the whole anterior diameter of the uterus, was observed about the middle of its body: through this opening, in the enlarged state of the uterus, the child and placenta had passed. The intestinal canal was inflated through its whole extent. The other viscera of the abdomen, as far as they were examined, assumed a healthy appearance. From the attending midwife, and the patient's friends, I obtained some particulars of the progress of the labour, and other circumstances. This poor woman, æt. 35, was of a corpulent habit, the tendency to which had very considerably increased during her last pregnancy. She had born several children, and usually had lingering labours. She began to be in labour on the Monday evening preceding, and early on the Tuesday morning, the midwife was sent for, who arrived about five o'clock. Before the arrival of the midwife, according to the representation of her friends, she was in strong labour. On examination, the midwife could not determine the presenting part of the child; the os uteri was a little open, and the membranes entire. The pains continued to increase; and after some hours the membranes either gave way spontaneously, or were ruptured. After this, the midwife felt some part of the child very high, which she believed to be the head, and waited patiently in expectation of its descent. As this poor woman had, in her former labours, suffered considerably, the midwife's apprehensions were not excited by the child's not advancing. About noon Tuesday, the patient complained to her sister, after a violent labour-pain, that her burden had suddenly risen much higher; that she had a pain about her heart, (as she said) with very considerable difficulty of breathing, and a sense of suffocation. From this time, the regular pains almost ceased; but the poor woman complained of great uneasiness in the belly with the sense of suffocation; yet she was not entirely prevented from moving about. Shortly afterwards she was seized with vomitings of a black offensive substance, which continued at intervals during the remainder of life. on Thus hour after hour passed away till the next morning, the midwife being in constant attendance, and occasionally making an examination, but found no advance in the labour. Early on the Wednesday morning, the belly was observed to be be swelled more than usual, and after a while symptoms of a convulsive nature made their appearance; upon which, the midwife requested the assistance of an eminent practitioner, but before he was able to see the patient, she had breathed her last about noon on Wednesday. In this case, rupture of the uterus occurred from the contractions of that organ upon the child in an adverse position; and the opening was sufficiently extensive to allow of the sudden passage of the child and placenta into the cavity of the abdomen, after which the uterus contracts itself. Under this unfortunate accident, it rarely happens that the child is entirely protruded out of the uterine cavity: it commonly is found partly in the uterus, partly in the abdomen. It also seldom happens that a patient lives so long after the accident as in the present instance: her continuance under her sufferings might possibly be owing to the perfect escape of the child from the uterus, and to its subsequent contraction. I enquired particularly respecting any appearance of external hemorrhage, and was answered that there was very little colored discharge, but that little was very offensive. The contracted state of the uterus explains a want of hemorrhage. In this instance, after the accident had taken place, and the uterus had contracted itself, delivery by the natural passages would have been impossible; the patient must have been left to her fate. I will make no comments on the practice a judicious ope rator would have pursued had he been called before the rupture of the membranes: the very nature of the presentation would have determined that point. Difference of opinion has existed in the minds of medical men as to the best practice under cases of rupture of the uterus: for my part, immediate delivery by turning the child, when that is practicable, seems the only alternative offering a chance either to the mother or child. In the above case, the accident was not suspected. An ACCOUNT of an ABDOMINAL PREGNANCY. In the beginning of July last, Mrs. P. æt. 40, presented herself to the physician of a public dispensary for relief under a violent diarrhoea of long standing, attended with considerable pain in the abdomen, and general emaciation. She, however, did not then disclose any of the circumstances hereafter to be detailed, which would have afforded a clue to the real cause and nature of her complaints. Some medicines were directed for her, and she was desired to attend again. A few days afterwards she died; and having always supposed supposed herself, contrary to the belief of her friends, to be pregnant, she had given orders that her body should be opened after death to ascertain the fact, or to determine the cause of her singular symptoms. Being in low circumstances, the body was removed to the poor-house of the parish in which she died, and the surgeon employed by the parish, who had never seen or heard of the case during life, was requested to inspect it. Upon opening the abdomen in the usual manner, there appeared in that cavity evident marks of long-continued inflammation; the peritonæum lining the abdominal muscles was closely and pretty generally adherent to the omentum and intestines, particularly at the lower part and on the left side; the omentum was altered from its natural appearance, was darker colored, and looser in its texture. From its general adhesion, the omentum could not be reflected upwards; but with little difficulty it was separated from the parts underneath, and this separation exposed a cavity containing numerous bones of a well-grown fœtus in a very putrid state, lying huddled together, but separate from each other, and intermixed with them a small quantity of an offensive dark-colored fluid. Even the bones of the head and of the pelvis were detached from each other. The bones being removed from their situation, and the cyst containing them cleaned out, it was found that the posterior parietes of the cyst were formed of the colon, mesentery, and neighboring parts; and that its anterior parietes were composed of the omentum, and the adhesions of the peritonæum lining the abdominal muscles. The extremity of the fallopian tube was lost in the general mass; and at that point where the cyst was united to the colon, absorption or destruction of a portion of that gut had taken place, so that an opening into the cyst, and out of it from the colon, was apparent. The size of the bones determined the foetus to have reached the sixth or seventh month. The uterus itself was not in the least enlarged; the os uteri and the whole of its surface had a natural healthy appearance, as had likewise the right fallopian tube and ovaria. From the husband of the deceased, and different individuals of her acquaintance, some interesting information has been obtained. This poor woman supposed herself to have conceived about the latter end of March or beginning of April 1812, for till near this time her catamenia had been regular, and she had been in good health; but after this time menstruation had disappeared. About nine years ago she bore a living child, and in the intermediate time had had two miscarriages. In the early part of this pregnancy she suffered greatly from sickness at stomach, violent pains in the belly, |