A manual of obstetrics : theoretical and practical / by W. Tyler Smith.

  • Smith, W. Tyler (William Tyler), 1815-1873.
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: A manual of obstetrics : theoretical and practical / by W. Tyler Smith. Source: Wellcome Collection.

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    coma between the convulsions becomes more continuous and profound. As regards the Treatment of the form of puerperal convul- sions depending on ursemia, the latest experience is against excessive bloodletting, and, indeed, against bleeding at all, except in the form of a single venesection at the outset of the disease, inpatients of full habit. Chloroform has been found of great service in moderating the violence of the fits, and in rendering operations, such as the use of the forceps in turning, comparatively easy of performance. It is also be- lieved that a transient diabetes mellitus is caused by the inhalation of chloroform, and that this condition neutralizes to some extent the saturation of the blood with urea or car- bonate of ammonia, and that chloroform has thus a curative effect in addition to its anaesthetic influence. The remaining indication is to complete the labour, when the convulsions occur during the course of parturition, as early and with as little irritation as possible. As the rule, craniotomy should not be performed, on account of convulsions alone, unless there be evidence of the death of the child. The forceps should be used when the head is within reach, and the os uteri sufficiently dilated. It has been recommended in those cases where the head is high in the pelvis, to use the forceps after Hatin’s method—namely, by introducing one hand entirely into the vagina while the blades of the forceps are being passed up, so as to direct them to the head. In cases of I rigidity of the os uteri, labour should be promoted by the means used for the induction of premature labour. No means are probably superior to the injection of two or three quarts of warm water into the uterus itself, by passing a tube up I between the membranes without rupturing them. Professor I Braun recommends the introduction of a caoutchouc bag iutol the vagina, and its distension with water, as a means of I dilating t he os uteri, and also advises incision and cauteriza-l l ion of the os. Incision should, however, only be practisedl in cases in which it would be necessary if the labour was notl complicated with convulsions; and the author referred to,I gives no sound reason for the employment of cauterization I In this country it is sometimes the practice to perform c rani-I otomy when the head is low in the pelvis, to avoid injury and sloughing of the periuauim; but the propriety of tliis may very well be questioned. It would be better to lacerate the penuroum by the use of the forceps, or even to incise it if]