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facts and inferences deducible from a sanatary survey and registration, interest and benefit, directly, the great mass of the people, for all are interested in their personal condition. Thus are produced in them more expanded views of the worth of life, and the necessity for its preservation; a more thorough appreciation of the importance of purity in the principal sources of its continuance, air and food; more attention to the comforts of dwell. ings and clothing, more refined sensibilities, greater energy, and a better regulated state of public and private morals. These results have been obtained in Geneva.
In Prussia these measures are attended to in a mode deserving the highest commendation. Every fact relating to the health, lives and condition of the population, is there collected with great care by a central officer at Berlin, and published for the benefit of the people. The most beneficent results have accrued from the admirably arranged statistical returns made for several years past tin England. Of more than one large town, but of Liverpool especially, it was ascertained that the mortality was great, and the average age at death of the population low, whereas before, the inhabitants had boasted of their salubrity and longevity. The registration has, to them, truly proved the means of increase of health and years, after removing from their eyes the scales which blinded them to their own destruction.
In many of the European states besides those mentioned, facts in connection with this subject are registered, and collated, in the most scientific and systematic manner, and, to use the language of a distinguished American statist, “whatever we Americans may say to the contrary, the average longevity, in many places, where these measures have been in operation, appears greater than with us." Indeed we have no little reason to apprehend that unless something is done to arrest the progress and pressure of the causes of premature mortality in this country, we shall be in danger of possessing only a very young and immature population. The average age of death in many of our large cities, as far as returns enable it to be shown, is under twenty years, a fact which can only be due to the unfavorable physical circumstances of the people, and their ignorance of the true means of living and avoiding disease.
The registers of the ancient Romans, which were preserved with great care, and recorded the births, sexes, periods of puberty, manhood, age of death, etc., kept by order of Domitius Ulpianus, prime minister of Alexander Severus, afford us the means of ascertaining the mean duration of life in Rome nearly two thousand years ago, and comparing this with the re
sults of estimates made at the present day in places where similar records are kept, we are thus enabled to establish the gratifying fact of the great extension of the average period of human life in various cities and countries.
Of the results obtainable by the suggested measure, in connection with the census returns now regularly made in each of the United States, not the least important and desirable are tables exhibiting the probabilities or expectation of life.
By this simple and elegant method, the mean duration of life, uncertain as it appears to be, and as it is, with reference to individuals, can be determined with the greatest accuracy in nations, and in still smaller communities. This is important not merely in reference to the payments of life annuities, and the bnsiness of life insurance, whose great value is but just beginning to be felt in this country, but it is of inestimable interest, as determining to individuals their probabilities of living in their different classes, occupations, locations, and habits. " As it might be expected from the similarity of the human organization, that all classes of men would, cæteris paribus, live, on an average, the same number of years, it becomes important to ascertain whether this be the case, and if it be not, to determine to what extent life is shortened in unfavourable circuinstances. The Life Table answers this purpose, and is as indispensable in sanitary inquiries as the barometer or thermometer, and other instruments, in physical research. Upon applying it to any number of well-selected cases, the influence of any external cause, or combination of causes, can be analyzed; while without its aid, and extended observation and calculation, we are liable to be misled at every step by vague opinions, well-concocted stories, or interested statements, in estimating the relative duration of life; which can no more be accurately made out by conjecture, than the relative diameters of the sun, moon, and planets of our
If these things are so, and of their truth there cannot remain the shadow of a doubt, it is plain that with this measure are entwined the highest earthly interests of humanity, and it belongs to the legislators of the New World, the guardians and custodians of the interests and glory of the American Republic, to consider well ere they longer postpone the adoption of a measure so essential thereto. “ A comparison of the duration of successive generations in England, France, Prussia, Austria, Russia, America, and other States, would throw much light on
*Fifth Annual Report of the Registrar-General in England.
the physical condition of their respective populations, and suggest to scientific and benevolent individuals in every country, and to the governments, many ways of diminishing the sufferings, and meliorating the health and condition of the people ; for the longer life of a nation denotes more than it does in an individual, a happier life--a life more exempt from sickness and infirmity-a life of greater energy and industry-of greater experience and wisdom. By these comparisons, a noble national ennulation might be excited, and rival nations would read of sickness diminished, deformity banished, life saved- of victories over death and the grave,- ,—with as much enthusiasm as of victories over each other's armies in the field; and the triumph of one would not be the humiliation of the other, for in this contention none would lose territory, or honour, or blood, but all would gain strength."-Idem.
A case of complete Placenta Prævia, turning with Perforation
of the Placenta-Death on the third day by Puerperal Fever. By William C. ROBERTS, M. D., Editor of the New York Annalist.
We little thought, when we presented to the readers of this Journal the review of Negrier's work upon the complication which forms the subject of the following history, that it would so soon fall to our own lot to test the value of the practice therein recommended, and of our own comments upon its merits. But so it is. Ours is a profession teeming with emergencies; for all of which, it behooves every one who undertakes to engage in the responsible duty of the obstetrical art, to be always prepared.
Mrs. S., aged about 26, the wife of a respectable tradesman living in Division street, an amiable and exemplary woman, was, when about seven months gone in her third pregnancy, the subject of a small uterine hæmorrhage, occurring without particular cause. A sanguineous discharge continued for about three weeks afterward, and then ceased spontaneously. In a week afterward, while asleep, she was awakened by a discharge of blood of very considerable amount, which was shortly succeeded by a third. At this time I saw her, and, the hæmorrhage having ceased, cautioned the husband as to the possible gravity of the occurrence, and advised complete repose, &c., until the natural period of delivery should arrive. I have reason to believe that this advice was not attended to. Having taken a dose of physic upon the morning of August 18th, she was, while under its operation, surprised by a gush of blood, equal, it is said, to two quarts. She rose from the chamber, lay down upon the floor, and fainted. When I reached her, she had revived, and the hæmorrhage had ceased. She was pallid, the skin of moderate warmth, and the pulse, not weak, but remarkably quick and frequent. I placed her upon the bed ; examined; found the neck long and thick; the os dilated to the size of a two shilling piece, not very dilatable, and above it, as far as I could reach in every direction, by such examination as I deemed safe, the placenta. I plugged the vagina very acurately with sponge and a silk bandkerchief, retained the whole with a T bandage, administered a little nourishment, and enjoined perfect repose. I passed the night with the patient, prepared to act upon the first indication of need. I did not turn and deliver immediately, because I thought the os scarcely adapted to the operation, and the necessity not immediately urgent. · The pulse continued very frequent all night, and a few slight pains were felt from time to time. In the course of the night, I drew off the urine by the catheter. About daylight of the 19th, the napkin outside of the vulva became moistened with the flowing of the liquor amnii ; soon after, it became tinged with blood; later still the patient became conscious of its escape, alarmed, and agitated. Blood, too, began to trickle in small streams down the thighs, and the countenance assumed an increased pallidity: The pulse maintained its frequency and tension. I removed the tampons, much clotted with blood, and examined. The walls of the neck of the uterus were thinner; the os more dilated and more dilatable. Two enormous clots now rolled out of the vagina, and fluid blood began to issue freely, in a warm stream. The agitation of the patient increased. I placed her as quickly as possible across the bed upon her back; the blood flowed freely in the change of position, to her increased alarm and pallidity. I passed my right hand boldly through the placenta, with momentary increase of hæmorrhage, arrived easily at the feet, and, with no more than the usual delay, delivered her of a child which died in my hands before the head was extricated. . I felt its last convulsive struggle. Blood again flowed freely. I passed my left hand into the uterus, giving the child to be held by a bystander, and without stopping
to separate the chord; stimulated the uterus to contraction, grasping the placenta, which with my hand was expelled by its action. No syncope occurred. No blood of any consequence followed the delivery. During the hour which elapsed without her changing her position, lest such might occur, I applied wet cloths, and made slight frictions. I adminis
tered, also, brandy and Inf. of Ergot. At the end of this time, she had become excessively tired of her position, and begged to have it changed. I prepared a cot, and carefully placed her upon it. This was injudícious. The patient was enfeebled by the motion, and the uterus relaxed. No blood, however, flowed. By frictions and cold, it again repeatedly imperfectly contracted, and entirely relaxed. After some tinie, having obtained a tolerable fair degree of hardness of the womb, and no blood flowing, I applied compresses and a double binder, and retired, enjoining perfect repose, and the administration of a little stimus lus. The belly was already tympanitic, and the pulse hard, small, and extremely frequent. On my return, in two or three hours, I found her in statu quo, except that she complained of great soreness of the left side and abdomen, and pains like after pains. She had rejected by vomiting the drinks administered, and some coagula had escaped. I administered a large anodyne, and evacuated the bladder by the catheter. At a subsequent evening visit, I found the soreness, pains, and vomiting unabated. The abdomen was excessively
, tympanitic. I removed the compresses, and, having no longer any fear of hæmorrhage, I applied flannels wrung out of hot water to the abdomen, which were assiduously continued during the night. These were subsequently changed for thin, hot Indian mush poultices, which were continued until the day of dissolution.
The anodyne was repeated at bed time. The patient had urinated naturally. On the morning of the 20th, things remained much the same. The abdomen was excessively tympanitic; sore, but not tender to the touch. The stomach retained nothing, brandy disgusted her, and, after several fruitless attempts to administer nourishment, in various forms, ice only was recommended, as thirst was urgent. The skin was warm and dry; the tongue moist, broad, and pale ; the countenance natural; the lochia sufficient, the pulse uncommonly frequent, small and tense. Pills of Camphor, Opium, and Calomel every two hours were ordered. In the evening, things remained much the same. One pill had been retained ; the second was supposed to have been rejected by vomiting, and no more had been given. The soreness was much complained of. I administered grs. xv. of Calomel, which being, in part, immediately rejected, I repeated the dose. This, with a large anodyne, was retained. At 3 A. M., I was called to her, in consequence of a violent exacerbation of pain, which was somewhat less on my arrival. The pulse was small, hard, and frequent. The tympanites being urgent, I threw up a large turpentine enema, with relief, and a bilious evacuation; a sina.