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.

    17/50 (page 15)
    vaginal tampon as employed by Schbller; but the results can scarcely be re¬ garded as favorable to the proceeding since uterine action was not induced in the first case till after 40 hours, and in the third till 23 days, [during the whole of which time the child must go on increasing in size, and the advantages of the operation be daily diminishing.] Von D’Outrepont* prefers puncture of the membranes to any other mode of inducing premature labour ; concerning which he has concluded after giving them a trial, that they are either uncer¬ tain in their action, or expose the mother to risk, or at least to pain and an¬ noyance far exceeding that produced by puncture of the membranes, or else they peril the child still more. An interesting case is recorded by Drs. Hoeniger and Jacoby,t in which they employed galvanism to excite uterine action in a case where the introduction of sponge tents into the os uteri, and the administration of the ergot of rye had been had recourse to without effect, in order to induce premature labour. The use of an electro-magnetic appa¬ ratus was immediately followed by the reexcitement of uterine action. Its use was continued only for half-an-hour, at the end of which time the os uteri was so far open that the membranes could be easily ruptured, and in another half hour the child was bora alive. Uterine hemorrhage. M. Loir and Mr. Thompson,! both record a case of fatal internal hemorrhage, occurring before the birth of the child. In M. Loir’s case, the symptoms of faintness, exhaustion, &c., occurred in the 7th month of pregnancy, and were almost unattended with uterine action. The os uteri was undilatable, and delivery was effected by incising it, and extracting the child. The patient soon died; and on a post-mortem examination the placenta was found detached at its centre by an immense effusion of blood between it and the ute¬ rus. Mr. Thompson’s case closely resembles the preceding in the sudden ac¬ cession of faintness, and the almost total absence of uterine action. The pa¬ tient died undelivered, the placenta being completely detached from the uterus, and an immense effusion of blood having taken place between the membranes of the ovum and the womb. In neither case was there the slightest escape of blood externally. [Cases similar to the above have been collected by Baudelocque in his essay on this subject, and are referred to by Velpeau, Traitd des Accouchemens, tome, ii, p. 88 ; a case is likewise mentioned by Mr. Crowfoot, in Ed. Med. Surg. Journal, Oct. 1824; and another by the late Dr. Ingleby in his Lectures.] Unavoidable hemorrhage. Dr. Simpson,§ in a very interesting paper on this subject, has collected 14leases of placenta presentation in which that body was either expelled or extracted before the child; only 10 of which were followed by the death of the mother, while 115 out of 399 cases of placenta previa, treated in the ordinary way proved fatal. It furtlierappears that the presence or absence of flooding after complete separation of the placenta is not influenced by the length of time that elapses between its detachment and the birth of the child. It was apparently a knowledge of these facts, though not an acquaint¬ ance with their full extent, that induced Mr. Kinder Wood|| to recommend the complete detachment of the placenta in some cases of unavoidable hemorrhage. This practice has with certain modifications been advocated by Dr. Radford^T of Manchester, and has likewise been followed by Dr. Simpson of Edinburgh, though he does not seem to have a fair claim to the honours of priority in its adoption. Dr. Radford aims to discountenance the too great haste in resorting to * Neue Zeitschrift f. Geburtsk. Bd.xvi, Heft 1. t Ibid. Heft 3. I Revue M^clicale, Aout 1844; Med. Gazette, Nov. 29, 1844. § London and Edinburgh Monthly Journal, March 1845. To these eases may be added another similar one by Mr. Tennent, Lond. and Edinb. Monthly Journal, June 1845. || Extracts from Mr. Wood’s lectures, and copies of some of his cases are given by Dr. Radford, in Prov. Med. and Surg. Journal, Feb. 26, 1845. Provincial Medical and Surgical Journal, Dec. 24, 1844, and Jan. 22, 1845.