Monthly retrospect of the medical sciences : February to December 1848 / edited by Alexander Fleming and W.T. Gairdner.

Date:
MDCCCXLVIII [1848]
Catalogue details

Licence: Public Domain Mark

Credit: Monthly retrospect of the medical sciences : February to December 1848 / edited by Alexander Fleming and W.T. Gairdner. Source: Wellcome Collection.

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    IG he does not recollect having seen any one who had had so severe a labour, arrive at so speedy a restoration to health.—Lan¬ cet, p. 42, Jan. 8, 1848. [In this case, the safe precaution of punctm’ing the tumour vaginam seems to have been omitted. The introduction of a small exploring needle (trocar and canula) would have decided whether or not the tumour contained fluid, and of what kind the fluid was. If the tumour was ovarian, this means might probably have evacuated its contents, and allowed the child to pass uninjured. The fibrous hardness of the tumour is no test, under such circumstances, of its containing fluid or not. Dr Ingleby {Obstetric Medicine, p. 125) relates a case in point, w'here the tumour was “ so very tense as to feel like bone and where it was ascertained that, had it been punctured, the child would probably have survived.] 30.—Turning substituted for Cranio¬ tomy and the Long Forceps. Chloro¬ form-inhalation. By Dr Murphy_ Dr Murphy was called to attend a lady in labour with her twelfth child. All her former labours were more or less pro¬ tracted, and in her last confinement the forceps were resorted to in vain, after labour had continued forty-eight hours. The cranium was then perforated, and the child delivered. “ When it was removed, the arm of a second was found in the vagina, which was turned with much dif¬ ficulty and saved.” On the present occasion labour com¬ menced on Thursday, Dec. 2d. “ On the following morning (says Dr Murphy) she sent for me, when I found the os uteri two-thirds dilated, the head of the child presenting at the brim, the passages cool, and the upper part of the sacrum easily touched by the fore-finger ; the contrac¬ tion from pubis to sacrum seemed to me to be about three inches. I hoped, there¬ fore, that by allowing the labour to pro¬ ceed, the head might advance sufficiently to be delivered by the forceps. Nothing was done until the middle of the day, when I saw her about one o’clock. During this interval the pains were be¬ coming very weak and inefficient; the pulse 100, weak and compressible ; no advance in the presenting part, which was still in the brim of the pelvis. I deter¬ mined to attempt the delivery by the for¬ ceps, and requested Dr Snow to commence the inhalation of chloroform. As soon as my patient was sufficiently under its in¬ fluence, I proceeded to apply the long forceps in the transverse axis of the brim of the pelvis, over the head of the child ; when the blades were locked, I gradually increased the extracting force to the utmost I could use, but without any elfoct; I was more than half an hour engaged in this, but to no purpose. Thus, finding my intentions defeated, and having, as I sup¬ posed, no other alternative, I proceeded to perforate the head, when the perfora¬ tor, which had scarcely entered the cra¬ nium, pushed the head altogether above the brim of the pelvis. I withdrew the instrument, and feeling a hand of the child just over the pubis, I resolved to attempt to turn it. I got my hand and arm, with a good deal of difficulty, through the brim, seized the knee of the child, and brought it down, which being accomplished, I was enabled to bring down the remaining limbs more easily, because the cavity and outlet of the pelvis was just as wide as the brim was narrow. The extraction of the head, the great difficulty, was yet to be overcome, but by a steady and powerful effort I succeeded in disengaging it; the child (a boy) was born, to my great sur¬ prise, living, and is now doing remarkably well. “ Since the operation, this lady’s reco¬ very has been extremely favourable; and, comparing it with her last confine¬ ment, she says that she slept better, and felt far more comfortable on the following day. She had much less nervous irrita¬ tion. She is also quite free from after pains, to which she had been subject in every previous confinement. ... It seems to relieve the patient from the shock to the nervous system, caused by severe pain. “ This case (continues Dr M.), I think, also proves the importance of a rule pro¬ posed by Professor Simpson — that of turning the child where the long forceps fails in extracting it. [(See the No. of Journal for March 1847, p. 718.] I should have no hesitation, in any future case similar to this, to make the attempt, if I could get my hand and arm through the brim of the pelvis.”—Lancet, p. 654, Dec. 18, 1847. 31.—On Placenta Po'cevia.—By Dr Mea¬ dows.—Dr Meadows of Ottley, Ipswich, relates a case of this complication. The patient had had repeated discharges of blood during the two last months of her pregnancy. When labour came on, it was attended with excessive hemorrhage. Tlie mother was completely exhausted and almost insensible, in consequence of which brandy and opium were administered. Dr Meadows, on examination, found the os uteri completely dilated, and the pla¬ centa entirely adhering to its circumfer-
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