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.

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    adopted with success. This modification consisted in bringing the edges of the wound together by the interrupted suture, after removing a strip of vagi¬ nal mucous membrane lg inches broad. The contraction of the vagina thus produced was very considerable, and the cure was permanent. Professor Blasius* describes a new operation for procidentia of the uterus, which con¬ sisted in the insertion of four circular ligatures beneath the mucous membrane of the vagina, bringing them out again into the passage, then reintroducing them under the mucous membrane, and thus causing them to surround the whole vagina. In the case which he relates the inflammation excited by these ligatures was sufficient to produce a contraction of the whole passage, such as retained the replaced uterus in its proper position, where it continued at the end of eight weeks. Dr. Toogoodf relates the particulars of a case of pro¬ cidentia of the uterus of long standing, in a lady aged 60; in which the organ havingdescended 7 or 8 inches beyond the external parts, and being quite irre¬ ducible, he applied a ligature round it, and then cut it away. It weighed two pounds, its cavity was obliterated, and its suhstance had acquired an almost cartilaginous hardness. The patient whose health was previously much im¬ paired, recovered perfectly. Retroversion of the uterus. Cases of this accident occurring in the unim¬ pregnated state, are related by Dr. v. Kiwisch, Dr. Helmuth, Mr. Whitehead, and Professor Trefurt4 In Dr. v. Kiwisch’s case, the displacement was pro¬ duced by the pressure of a cyst which was most probably ovarian. The cyst suddenly burst into the rectum, whereupon the uterus returned to its natural position. In the second case it seems to have come on spontaneously. Only a week elapsed from the occurrence of the first symptoms to the supervention of complete retroversion. Attempts to effect reposition did not succeed, and were followed by an attack of uterine inflammation. As this subsided after rather active treatment the uterus began to return to its natural position, which at length it completely regained. Mr. Whitehead’s case presents many instructive features. The uterus became retroverted in the first pregnancy, but the accident was remedied, and the patient was confined at the full period. The same accident occurred in the succeeding pregnancy, and was followed by abortion in the 3d month, and on two subsequent occasions the patient aborted at the same period. After each abortion she had the sensation of the womb not being in its proper place, and when Mr. Whitehead became aware of the real nature of the case, all attempts at reduction failed. The patient had been for some considerable time under medical care, before the real nature of her ailment was discovered, owing to an examination per rectum having been omitted. [It is probable that the abortions and the irreducibility of the retro¬ verted uterus depended on the organ having contracted adhesions with sur¬ rounding parts, as described by Madame Boivin in her Recherches sur une des causes de l’Avortement.] The case related by Professor Trefurt is interesting, as having presented all the symptoms of retroversion in a very marked degree. The displacement appears to have existed for five years; ever since the birth of the patient’s only child. No attempt at reposition could be made till after local depletion and other preliminary treatment had been adopted. It was then found impossible to exert any force on the misplaced uterus, without ex¬ citing most excruciating pain. A peculiarly-constructed pessary, invented bv Dr. Sander, of Brunswick, and called by him mochlo-pessum, or lever-pessary, was introduced, and eventually tolerated by the patient. At the end of tvvo months the uterus had become more moveable, and was more nearly approx¬ imated to its natural situation, and in a few weeks more the misplacement was completely removed. [This instrument of which a description and drawing are * Med. Zeitung, Oct. 9, 1844. + Prov. Med. and Surg. Journ. July 10, 1844. X Oesterr. Med. Jahrb. Feb. 1844 ; Casper’s Wochenschr. Oct. 5, 1844 ; Med. Gazette, Sept. 18, 1844 ; and Op. cit. p. 280. '2