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1889 The Lancet  
MRS. Mwas confined of her second child on Dec. 16th, 1888. Labour began at 3 A.M., and I was sent for at 11 A.M. The pains were strong, and the os was well dilated, but the head would not come down, so I delivered her with forceps at about 1.45 P.M. Great difficulty was experienced in delivering the shoulders. The cord was round the neck of the child once, and was very tight. Traction applied to the axilla produced very little effect, and simultaneously with each effort at traction the child's
more » ... action the child's face became livid, resuming its natural colour again during the intervals between traction. As the cord was too tight to pass over the head or shoulders, I tied it in two places where it was round the neck, and divided it, when the shoulders were immediately born with the greatest ease. The child's heart was beating well, but respiratory movements were absent; these, however, were well established after two or three minutes. The cord was unfortunately not measured, but its length was about twelve or at the most fourteen inches from placenta to umbilicus. I examined the patient almost immediately after delivery, and found the placenta in the vagina. Where there is every prospect that delivery of the child will immediately follow division of the cord in circumstances similar to the above, this would appear to be a much safer mode of treatment than waiting till the child and the placenta are both expelled together. Uxbridge. THE son of Mrs. Ssent for me on Sunday morning Nov. 12th, to see his mother. Death, however, had occurre( before my arrival. The coroner, Mr. Braxton Hicks directed me to make a post-mortem examination. Till deceased, I learned, was seventy-three years of age. found the body well nourished. On opening the thorax the pericardium was distended by fluid and clotted blood on removing this, a rupture, three-quarters of an inch long could be seen on the anterior surface of the left ventricle this extended through its walls into the cavity, and from i blood could be made to flow by pressure, the cavity of the ventricle being full. The right ventricle was empty, an( the tricuspid orifice slightly dilated ; the valves wer healthy. The mitral valves were somewhat thickened The heart was not enlarged ; the muscular substance wa! mottled in colour, softened, and very easily lacerated ; the fibres, examined under the microscope, had undergone fatty degeneration. A large gall stone almost entirely filled the gall bladder, and a small hard tumour was foun( at the lower border of the omentum adherent to th4 peritoneum and intestines. The following history of the case was given me. Thf general health of the deceased was very good. Thre years ago she had an attack of syncope, which lasted cm hour and was attended by partial unconsciousness ; sinc then she has been well, with the exception of experiencin! shortness of breath when she has had to go upstairs She had recently an attack of jaundice, which quickly passed away, and since then she has complained of col( feet. She has never suffered from pain in the side, or sick ness. On the morning of her death she was about her usua duties, when she suddenly fell down, and died almos immediately. .RgmnrZ.—The abiding shortness of breath upon exertion, with the prolonged attack of syncope, would have sufficed during life to have called attention to the state of till heart. It is interesting to note that the large gall stone gave rise to but trifling, if any, symptoms. The place o: rupture was observed to be where the evidences of degenera tion were most marked, and, as in the majority of recordec cases, took place in the left ventricle and on its anterior sur face; the direction of the rent was in the course of the fibres and about one-third of the distance from the apex to the base.
doi:10.1016/s0140-6736(02)05099-7 fatcat:2x2gwa3ghffmndzongpjiwttii