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.

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    the accident was produced by some turn of the patient in bed, by which the uterus was suddenly inclined to the opposite side of the abdomen; when the diseased vagina gave way, being unable to bear the stress thus thrown upon it. The os uteri was found after death perfectly closed, and the rent of the vagina corresponded to the right linea ileo pectinea, which, however, was not sharper or more prominent than natural. Extra-uterine pregnancy. Dr. G. A. Cams* has published a paper on interstitial or tubo-uterine pregnancy, supplementary to his dissertation on the same subject which appeared in the year 1841. In this paper he relates more or less fully the particulars of fifteen cases, of which he has either found a description in medical writings, or has seen specimens in anatomical collec¬ tions. He distinguishes two varieties of this form of pregnancy : 1st, Graviditas utero-tubaria, in which the ovum reaches only to the point where the tube be¬ gins to enter the substance of the uterus, and by its development distends only the tube—not any part of the womb; and 2d, the Graviditas tubo-uterina, in substantia uteri, sine interstilialis, in which the ovum is developed in that portion of the tube which is actually surrounded by the uterine substance. Of the former occurrence, he relates three cases, the remaining twelve be¬ longing to the second class, and being specimens of true interstitial pregnancy. [The chief merit of the paper, consists in its being a very complete and clear description of all known cases of this unusual form of extra-uterine pregnancy.] Cases of fallopian pregnancy are detailed by Mr. Elkington,f M. Velpeau,]; and Dr. Lietch.§ Mr. Elkington’s patient survived for more than four years, and death then took place by the accidental strangulation of a fold of the ileum between two bands of omentum which were adherent to the cyst. M. Velpeau’s patient died at the end of two years, in consequence of a puncture of the cyst through the walls of the vagina and the supervention of peritonitis. Dr. Lietch’s patient died with symptoms of stone at the end of five years. The ovum had originally occupied the right fallopian tube, but had escaped into the abdomen, where it had formed adhesions with the right iliacus interims muscle on one side, and on the other had become connected with and ulcerated into the bladder. In the cavity of the bladder was a calculus of the triple phos¬ phate which had formed around a foetal tibia. Charleton, Wheatcroft, Bacchetti, v. Dam, Hiller, and Hemard,|j have each observed a case of ab¬ dominal pregnancy. In all these cases the patients died, though not always from the immediate consequences of the occurrence. In Charleton’s case death took place at the 9th month, pains, like those of labour, having then come on; but it appears uncertain how far the rupture of the cyst into the va¬ gina which was found after death was the result of efforts to turn the child which were made under a misconception of the nature of the case. Life was prolonged for three years in Wheatcroft’s case, the patient eventually dying from exhaustion. Fcetal bones had been passed per rectum, but it is remark¬ able that though the sac communicated very freely with the uterus there was at no time any discharge from the vagina. Dr. Bacchetti’s patient had labour- pains at the end of the regular term of pregnancy which subsided in the course of a fortnight, she afterwards gave birth to two living children, and it was not till ten months after the birth of the second, that the abdominal tu¬ mour grew soft, and that fever &nd diarrhea came on, which destroyed life five years and three months after the occurrence of the extra-uterine conception, v. Dam’s case is not very clearly described; but it appears to have been an instance of natural pregnancy, in which rupture of the uterus took place during labour, * Neue Zeitschrift f. Geburtskunde, Bd. xv, p. 161. t Provincial Med. Journal, Jan. 8,1845. J Gaz. des Hopitaux, Mai 6, 1845. § Lond. and Edinb. Monthly Journal, Feb. 1845, p. 106. || Med. Gazette, Feb. 16, 1844; Lancet, Feb. 24, 1844; Gaz. des Hopitaux, Oct. 24, 1844; Oppen- heim’s Zeitschr. Marz 1845, p. 361 ; Med. Zeitung, April 16, 1845; Lancet, Oct. 12, 1844.