Volume 1

Operative gynecology / by Howard A. Kelly.

  • Howard Atwood Kelly
Date:
1901, ©1898
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Operative gynecology / by Howard A. Kelly. 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.

    601/622 (page 555)
    Pliysoinetra in Pregnancy .—The commonest of all forms of physo- metra is that met with in pregnancy or in the puerperium. It is ofteaest ob- served in women with narrow pelves, where labor is protracted and where manual or other operative interference has been found necessary, and is always due to an infection by a gas-producing bacillus. It is still the common impression that the gas in the uterus is due to the en- trance or introduction of air from without, or to the formation of gas blebs in a dead fetus macerated in a moist medium. For example (C. Bamberg, Inaug. Dissert., Halle, 1877), in the ease of a primipara with prolapse of the cord, the patient was put in the knee-elbow posture and the cord replaced. The next day the patient had a chill, the pulse rose to 121, and the temperature was 41-1:° C, and percussion over the uterus yielded perfect tympanitic resonance. The child was pei'forated and delivered, and after the escape of the head a quantity of ex- tremely foul gases poured out of the vagina with the fetid waters. The child is always dead, and the waters, as a rule, ruptured when the tym- panites is found. The true cause of the tympany is the bacillus aerogenes capsu- 1 a t u s , and this is well shown by a case investigated by Dr. George W. Dob- bin, the first case in which the bacillus has been demonstrated ante-mortem {Puerperal Sepsis due to Infection %oith. the Bacillus Aerogenes Capsulatus, Johns Hojyhhis Hospital Bulletin, Feb., 1897). The patient, a Polish woman, had been in labor for two days, attended by a midwife. She was found by Dr. Dobbin in a state of extreme exhaustion, with a pulse of 130 to 140, and with a large dead fetus impacted in a pelvis, with a true conjugate measuring approximately 8 centimeters (3-^ inches). There were no regular labor pains, and there was a continuous escape of gas and frothy fluid from the vagina. A sweetish offensive odor was noticeable about the bed, and a distinct bubbling, crackling sound could be heard. The child was delivered by a craniotomy, and immediately following the delivery a large amoimt of offen- sive gas escaped from the uterine cavity. Great numbers of the bacillus aero- genes capsulatus were demonstrated in the fetus, placenta, and uterine lochia, and a fatal prognosis was given. Death occurred on the third day after delivery. No autopsy was allowed. Dr. S. Flexner saw the patient six to eight hours before death, and endeavored in vain to find any evidences of the formation of gas in the tissues remote from the genitalia. But six or seven hours after death the appearances presented were those of extensive gas formation everywhere in the soft tissues and serous cavities, and from the nose and mouth frothy bloody serum exuded, which in cover-slip preparations showed the characteristic bacilli. This is a confirmation of the prediction made by Welch and Nutta]l that many of the cases of supposed entrance of air into the uterine sinuses would be found to be due to infection with a gas-producing micro-organism. The diagnosis is made by percussing the tympanitic, distended uterus, sometimes helped by noticing the escape of fetid waters mingled vpith little gas bubbles. The uterus may contain a small quantity of gas, which always assumes