A practical treatise on midwifery / translated by T. F. Betton and edited by P. B. Goddard.

  • François-Joseph Moreau
Date:
1844
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Licence: Public Domain Mark

Credit: A practical treatise on midwifery / translated by T. F. Betton and edited by P. B. Goddard. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    or be imperforate throughout its whole length, as in the child from Auteui], no tedious, painful operation should be attempted, which might compromise the life of the patient, without offering much hope of success. In case of absence of the urethral canal, and imperforation of the urachus, puncture of the bladder may be performed, to save the life of the infant. How, and at what point should it be done ? Without wishing to establish any general rule, we may remark, that in a female child, the puncture should be made in the anterior wall of the vagina; in the male, either above the pubes or through the rectum. We should, ourselves, prefer the latter method. ARTICLE III.—MALFORMATION OF THE VAGINA. Occlusion, Absence, Contraction of the Vagina. We include in one article these divers anomalies, because the obstacles they occasion are nearly the same in all cases, though they may arise from different causes. Tire vagina may be imperforate naturally or accidentally, in a part or whole of the length. In some cases, the upper part is obliterated, the canal does not extend to the uterus, but terminates in a cul-de-sac at a greater or less distance from the vulva; in others, the upper part exists, but the lower is wanting : the vulva forms a kind of imperforate funnel. Lastly, this canal may be entirely absent. The causes of occlusion of the vagina are numerous; imperforation of the hymen is one of the most frequent, and most writers on midwifery have reported cases of it. A. Pare,* Amand,t and Mauriceau,! have given several. This occlusion may also depend on the congenital agglutination of the labia pudendi, or their accidental union, produced by a badly treated burn, inflammation, irritation, local contusion, or by variolous or syphilitic ulcerations. Amand§ quotes from David the case of “ a daughter of a citizen of Marseilles, whom her father sent to his country seat on an ass; the rough gait of the animal, or the hardness of the pack-saddle, galled the lider so much, that the excoriated labia pudendi, from want of care, became agglutinated together. She was married some time afterwards, and the husband, being unable to consummate the nuptials, conceived some suspicion as to the chastity of his bride, who soon explained matters by relating the history of her journey, which she had kept until then locked in her own bosom.” Although only a small hole remained through which the menstrual discharge escaped, she became pregnant, but David was obliged, at the time of delivery, to separate the labia by means of scissors. The vagina may also be closed by one or several membranes developed accidentally after conception, as in the case reported by Ruysch,|| of the wife of a tobaconist who could not be delivered, and in whom he was obliged to divide a membrane which he says was the hymen; then a second in the vagina, an inch above the first; after which the woman bore a healthy and well-formed child. The partial, like the general agglutination, may be congenital or accidental. In the first case, the vagina exists in the form of a dense solid cord, not canaliculated, or else is completely wanting; it may be reduced to a single cellular web, as in the case observed by M. Williaume, of Metz.IT In the second, it may ensue from criminal acts, similar to those done by the female lamp-lighter of Geneva,** who, in order to bring on abortion, injected into her vagina some sulphuric acid of commerce, and excited a violent inflammation terminating in adhesion, in consequence of which the obliterated canal could not give passage to the product of conception at the period of delivery, and she expiated the unnatural crime with the penalty of her life. This agglutination generally succeeds lacerations and lesions of the vagina, produced by a natural or by an artificial delivery. An English lady, thirty-six or thirty-eight years of age, of a vigorous constitution, and very corpulent, was delivered the first time at London, on the 11th of December, 1835, at four o’clock, P. M. The labour was tedious and painful; but terminated, by the natural efforts alone, after sixty hours of suffering, in the expulsion of a dead infant. Her recovery was uninterrupted; the menstrual flux appeared toward the end of February, 1836; on the 30th of March it was less copious and appeared no more. A tension in the lower belly and loins; a sensation of weight in the pelvis; swelling of the hypogastrium, accompanied by a capricious appetite; slight pain in the head, and some derangement in the digestive functions, gave rise to a suspicion of pregnancy. In the spring of 1S36 this lady came to Paris: on the 13th of the following July a slight discharge of blackish blood caused her to apprehend abortion. Dr. Macloughlin called in a midwife to ascertain her condition. The latter could not practise the touch, on account of a violent spasm of the vagina, which prevented the introduction of the finger. The physician himself was not more successful in his attempt. On the 30th of July we were sent for, and discovered an occlusion of the vagina. This canal terminated at the distance of an inch from the vulva. On exami- nation with the speculum we perceived a black spot, owing to a small clot of blood which closed a narrow aperture, into which we introduced a blunt probe: this aperture led us into a spacious cavity, formed by the upper part of the vagina, distended by a large quantity of altered and coagulated blood. In order to give exit to this foreign fluid, we introduced a female catheter, but not without difficulty and acute pain. Warm water was injected through the catheter, but, owing to its small size, no satisfactory results ensued. It was then evident that the symptoms of the lady were to be attributed neither to a spasmodic contraction of the vagina, as had been at first supposed, nor to pregnancy, and still less to an incipient abortion. The occlusion of the vagina being ascertained, the indication was clear that, to remove the symptoms and prevent their return, we must, 1st, give exit to the extravasated fluid; 2d, restore the vagina to its natural condition. Two methods presented themselves to our consideration: we might restore the vagina by means of a crucial incision, but this mode was not free from objection ; for, in addition to * (Euvres, liv. 84, chap. L., p. 978, in fol. Paris, 1598. f Nouvelles Observations sur la Pratique des Accouchemens. Paris, 1715, obs. 34, p. 145; obs. 58, p. 102; obs. 117, p. 312. 4 Loc. cit. obs. 231 et 495. § Loc. cit. obs. ler, p. 44. II Opera Omnia. Amstelodami, 1757. Observationes Anatomico-Chirurgicte, p. 20, fig. et obs. 22. II Bibliotheque Medicate, tom. ler, p. 137. Paris, 1828. ** Lombard. Archives Gendrales de Medecine, tome xxv. p. 568. 12
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