Observations upon the nature and treatment of difficult occipito-posterior positions of the head : founded upon an analysis of twenty-six operative cases / by Angus Macdonald, M.D.

  • MacDonald, Angus, M.D.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: Observations upon the nature and treatment of difficult occipito-posterior positions of the head : founded upon an analysis of twenty-six operative cases / by Angus Macdonald, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    tion on the left side of tlie vagina and abrasion of the riftht. The left blade had become fixed over the occipital tuberosity, and tlie ridit over the forehead. Fearing further tear, the forceps were re- moved, in expectation tliat the contractions would now complete delivery. But notwithstanding every legitimate effort to induce uterine action, the inertia i-emained profound. The forceps had to be reapplied, and delivery completed artificially, which was effected about 3.30 P.M. The uterus contracted fairly after expulsion of the placenta, and there was no post-partum hajmorrliage. The child, which was a male, was dead. In the evening, the patient was feverish, and felt much exhausted, the tongue coated and dry, pulse 120, respirations 50 per minute. No unusual tenderness over the abdomen. She had two Dover's pills, of five grains each, but during the night slept little, and next morning was still more exhausted. Pulse still 120, but exceedingly weak,—in fact almost imperceptible. Respiration 50; abdomen tympanitic, and great tenderness on pressure over the uterus. Patient ordered beef-tea and stimulants every half hour, a pill containing 2 grains of calomel and ^ grain of opium every five hours, and hot fomentations, witli turpentine stupes over the abdomen. At 1 p.m., she was much the same, but her nurse iiad been so very remiss as to give, her brandy only once. At 6 P.M., pulse sti'onger, but otherwise she continued the same ; at 10 P.M., she was evidently sinking; and at 11 p.m. on 22d, she died. A post-mortem examination was refused. As already stated, I do not think the operation is chargeable with the fatal issue in this case. The painful termination of the case was no doubt due to acute metritis supervening upon a specially tedious labour, occurring in a patient enf^bled by the coexistence of pulmonary phthisis. Ever after I first saw the patient, I was concerned lest we should have a cervical tear passing up into the lower portion of the body of the uterus. This opinion was grounded on the fragile condition in which the cervix was found. But I had no reason subsequently to the operation to believe that such a rupture had taken place. It is deeply to be regretted that the nimia diligentia cliiriirgice on the part of the student in attendance, should have been so per- versely directed. It is only a poor apology that the errors were committed under the influence of the best of motives. I think it had been better had both ciiloral and opium been withheld ; and certainly the frequent examinations during the first stage were alike injurious and unwarrantable. *' The nature of the injuries inflicted by the forceps upon the lacerable and irritable, but resistent soft parts, is typical of the class of cases I have just been discussing. A question might also be raised here, which is, to my mind, one of the most important and diflicult in practical midwifery, and it is this : When, in a case of rigid os, such as the above, is the proper
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