Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West.

  • West, Charles, 1816-1898.
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West. Source: Wellcome Collection.

    12/50 (page 10)
    born, and the patient did perfectly well. Dr. Davis* and Mr. ReardonfJiave each met with a case in which the lower segment of the uterus was separated in labour; the os uteri having been perfectly rigid and undilatable. In both instances the patient did well. Two cases of extreme obliquity of the uterus are detailed by Dr. Pellegrini and Dr. Bresciani di Borsa.f In the former case the abdomen was so pen¬ dulous that the uterus rested on the patient’s thighs. Delivery was effected by turning, but the woman died of metroperitonitis on the fourth day. In Dr. di Borsa’s patient the obliquity of the uterus was lateral, the womb hanging like a retort over the right ileum. This malposition was apparently owing to great deformity of the pelvis, which rendered the Caesarean section necessary from which the patient recovered. An instance of labour, complicated with prolapse of the uterus, very similar to Dr. Perfetti’s case recorded in the last Report, is detailed by Dr. Darbey.§ Dr. de Billi|| relates the history of a patient whose uterus became retro- verted at. an early period in her second pregnancy, and continued so, attended as utero-gestation advanced with very urgent symptoms, until the middle of the eighth month. A discharge of fluid then took place, and three days after¬ wards labour-pains came on. Externally the uterus seemed of natural size and form, but a large round tumour was felt between the uterus and rectum, and the os uteri was very high up, tilted five fingers’ breadth above the pubes, quite beyond the reach of the hand. Notwithstanding this misplacement the patient had always voided her urine, though with great difficulty. Dr, de Billi reduced the uterus by pressure on its fundus, exerted through the vagina, while counter-pressure was made externally. The child, which presented by the breech, was stillborn, but the mother recovered well. [This case fully substantiates the accuracy of Dr. Merriman’s observations in his Dissertation on Retroversion of the Womb, and adds another to the very small number of cases in which the womb has continued retroverted up to the commence¬ ment of labour.] Inversion of the uterus. The first part of a very valuable essay on this sub¬ ject has appeared from the pen of Mr. Crosse.1% The simple detail of facts has been his object in this part; but he promises in the second to consider the causes, diagnosis, and treatment of the affection. He proposes the terms de¬ pression, introversion, perversion, and total inversion to designate the differ- rent degrees of this accident, and describes minutely the mechanism of its oc¬ currence, during parturition. Its symptoms and immediate consequences are stated less fully, but will be examined in the second part of the essay. Cases of spontaneous inversion of the uterus during labour are recorded by Messrs. Barker, Crosse, Clarkson, and Edwards.** In Mr. Barker’s case the accident occurred about twenty minutes after the expulsion of the placenta; the hemor¬ rhage was profuse, but the uterus was reduced in the course of half an hour. The inversion was produced in Mr. Clarkson’s patient by the same pain as ex¬ pelled the child, and detached the placenta. There was great depression of the system, but not very severe hemorrhage : and the uterus was easily re¬ duced. In Dr. Edwards’s patient the inversion occurred after the expulsion of the child, the placenta being still partially adherent, and the hemorrhage very profuse. The uterus was reduced after the removal of the placenta, conside¬ rable internal hemorrhage subsequently occurred, but the patient recovered. Mr. Crosse’s case is interesting from the same accident having occurred once before to the patient. On both occasions it was connected with morbid adhe- * Dublin Med. Press, Jan. 15, 1845. + Ibid. March 19, 1845. i Archives Gen. de Medecine, Fevr. 1845. § Dublin Medical Press, Nov. 6, 1844. || Annali Univ. di Med. Febb. 1845, p. 312. An Essay on Inversio Uteri; in Trans, of the Prov. Med. and Surg. Association, vol. xiii, p. 285. ** Medical Gazette, April 5-12, 1844; Prov. Med. and Surg. Journal, June 12, 1844; Lancet, Dec. 28, 1844: Ibid. April 5, 1845.