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
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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.

    13/50 (page 11)
    sion of the placenta, which body was removed by the hand. On the second occasion of its occurrence, attempts at reposition instituted after the lapse of an hour were quite unsuccessful. In the cases related by Mr. Square, Dr. Esselman, Dr. Gazzan, and Dr. M‘Clintock,* it is either expressly stated, or may be fairly assumed that traction had been made by the funis to remove the placenta. The first of these cases shows the importance of not omitting1 to make a vaginal examination whenever considerable hemorrhage occurs, and continues after labour; since from that omission the inversion was not detected till ten days after delivery, at which time it was found to be irreducible. Dr. Gazzan succeeded in reducing the uterus on the ninth day, having previously brought the patient under the influence of antimony. In Dr. Esselman’s case, and in the two related by Dr. M‘Clintock, unsuccessful attempts to reduce the uterus had been made before the patients came under the care of those gentle¬ men, and the disease had passed into a chronic condition. The cases recorded by the four last-mentioned writers are important, inasmuch as they show the possibility of inversio uteri, not occurring, or at least not giving rise to well- marked symptoms until some hours or even days after delivery. Dr. Oldhamf relates six cases of labour complicated with polypus uteri, five of which have not been published before, none of them, however, occurred under his own observation. He notices the difficulty of ascertaining the pre¬ sence of polypi during pregnancy, and the fact that they by no means constantly derange the process of labour. The most dangerous symptom to which under these circumstances they may give rise, is serious hemorrhage. He recom¬ mends that unless such hemorrhage exist, no attempt be made to remove the polypus immediately after delivery. The cases he relates illustrate the differences with respect to this point of practice which different symptoms may render necessary. M. AubinaisJ relates a case in which the introduction of the hand to remove an adherent placenta gave rise to the discovery of a polypus of the size of an egg, to which the placenta was attached, and from which it could not be separated. The pedicle of the polypus was easily twisted off, and no hemorrhage followed its removal. No peculiar symptom indica¬ tive of its presence had existed during pregnancy. A case of labour obstructed by a longitudinal septum dividing the vagina into two cavities, only one of which communicated directly with the os uteri, is re¬ lated by M. Lesaing.§ The patient was safely delivered after the septum had been divided. Mr. Headlandf] has observed a case in which the birth of the child was obstructed by the presence of a large malignant ovarian cyst in the recto-vaginal pouch. The cyst burst under the pressure of the child’s head, and delivery was effected by the forceps, but death took place in twenty-four hours. An instance of osteosteatomatous tumour of the pelvis, causing an impe¬ diment to the passage of the child, and requiring the performance of cranio¬ tomy is related by Dr. Pellegrini.1T [Of all the causes of obstructed labour, none are so rare as the presence of osteosteatomatous tumours in the pelvis, of which two other observations only are on record; in Puchelt, de Tumoribus, etc. p. 48.] Rupture of the uterus, and laceration of the vagina. References are con¬ tained in the note to several fatal cases of rupture of the uterus or vagina, all of which occurred spontaneously independent of any manual interference, or of the existence of disproportion between the mother and child.** In five of * Provincial Medical and Surgical Journal, July 24, 1844; American Journal of Medical Science, Jan. 1844; Ibid. April 1844 ; Dublin Journal, May 1845. t Guy’s Hospital Reports, New Series, vol. ii. j Gaz. Medicale, Sept. 7, 1844. § Ibid. || Lancet, June 22, 1844. If Archives G£n. de Med., Aug. 1844. ** Rendell, Med. Times, May 4, 1844; Arnold, Prov. Med. and Surg. Journal, July 24, 1844; Wright, Boston Med. Journal, June 1844; Elkington, Prov. Med. and Surg. Journal, Sept. 11, 1844; Griscom, New York Journal of Medicine, May 1844; Adler, Neue Zeitschrift f. Geburtsk. Bd. xvii. Heft 1; Bond, American Journal of Med. Science, Jan. 1845; Pavetti, Gaz.des H6p„ 14 Juin 1845.