A Case in Doubt

Abstract

nerves in the tissues which are exposed to compression by the displacement. When the sickness continues longer than the first half of pregnancy, he thinks it may be due to hardening of the tissues surrounding the internal os, this condition having been found especially marked in four cases, out of a series of thirteen, in which the condition of the os and cervix was particularly noted.The treatment advised by him is rest in the supine position, on the back, in those cases where anteversion or anteflexion may be present, and replacement by pessary or any other means that may secure a normal upward movement of the fundus uteri.Vomiting in these cases usually begins very early ; in twenty-four cases out of forty-three reported by Mons. Guéniot, of Paris, it occurred, as in my case, before the end of the first month.The prognosis in this affection may be stated as decidedly unfavorable. In the thirty-two cases collected by Hewitt, there were eleven deaths and twenty recoveries ; the result in one case was not known ; seven of these recoveries followed manipulative treatment and replacement of the uterus.In one hundred and eighteen cases collected by Guéniot, there were forty-six deaths ; without abortion, twenty-eight ; after abortion or spontaneous premature labor, seven ; after induced abortion, eleven.The treatment seems to me should be directed essentially to changing the position of the body of the uterus relative to the cervix. The vomiting begins so early that it does not seem probable that the pressure of the surrounding soft parts, in the first weeks of pregnancy, can act as the exciting cause of so great reflex disturbance.The treatment by Copeman's method was not tried in the case I have reported, on account of objection offered to it by the family, and a fear on my part of exciting abortion, as I felt that in her prostrated condition, a fatal result would thereby probably follow.One morning in 188-, the selectmen of the town of -, directed me to assume charge of the body of one Matilda Ferguson, who had died the preceding day, and make due investigation as to the cause of her death. Such of the personal history and past physical condition of the said Matilda as concerns us at this stage of our paper may be told in a few words. She was a maiden lady of somewhat eccentric life and habits, who had lived the major portion of her seventythree years in the quiet and seclusion of her own cottage, fully up to the high standard of virtue which Socrates so much desired of his wife. Physically she was thin, bony and angular, and although for the last score of years she had suffered from a cough which gave her the reputation of being marked for a victim of phthisis pulmonalis, yet she rarely found it necessary to patronize a physician, and passed for one of those tough, wiry, weazened, chronic kind, which we so frequently see live far beyond our most sanguine expectations, and oftentimes finally die of some acute disease.During the two or three weeks immediately preced-1 Read before the Massachusetts Medico-Legal Soc...