On artificial dilatation of the os and cervix uteri by fluid pressure from above : a reply to Drs. Keiller of Edinburgh, and Arnott and Barnes of London / by Horatio R. Storer, M.D.

  • Horatio Storer
Date:
1863
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Licence: Public Domain Mark

Credit: On artificial dilatation of the os and cervix uteri by fluid pressure from above : a reply to Drs. Keiller of Edinburgh, and Arnott and Barnes of London / by Horatio R. Storer, 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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    ing obstruction of the lungs, ft is impossible to lose sight of the danger. To this I have repeatedly called attention on former occa- sions, and a marked and faial instance of its eflFect has just been communicated to me by toy friend Dr. Hitchcock, of Fitchburg. In view, therefore, of the risk referred to, I have not hesitated to impress upon the students at present temporarily in my charge, the extreme caution necessary in manual or operative interference dur- ing labor, the impropi-iety of qndeavoring to excite intra-uterine or intra-vaginal respiration, even by the method so ingeniously sug- gested by Dr. Jacob Bigelow, of this city,* and also the possibility of air sufficient to produce fatal syncope being thrown into the ute- rine cavity where premature labor is induced by the injection of wa- ter between the membranes aiM uterine walls, as in cases of death related by Guillier, Germann, Chiari and others. In the instances of the new method reported by Drs. Keiller and Murray, dilatation was effected by India-rubber sacs into which air was forcibly thrown. Against rubber for uterine or vaginal appli- cation, used in any form except vulcanite, which as yet is afforded us in too unyielding a state, there is the insuperable objection that it is chemically acted upon by the fluids with which it comes in con- tact and becomes at once offensive and irritating. If distended to any great extent, it is very liable to rupture, and if this be guarded against by an increase of thickness, the introduction of the sac be- comes proportionately more difficult. In the use of thin animal membrane for dilatation the same liability to rupture exists, unless, as suggested by Arnott, a delicate layer of a stronger substance, as silk, be interposed between two layers of the membrane. In prac- tice I have more than once ruptured the membrane during its dis- tension by water, and therefore know that what I have asserted of such danger where air is used, is not unfounded. What, then, can be said of the deliberate use and recommendation of air under these circumstances ? Is it not an unjustifiable exposure of the pa- tient's life to a grave and unnecessary risk ?t To one other objection that might be alleged I must call atten- tion, merely to state my belief that it is unfounded. There is no doubt that in the induction of premature labor by the injection of water at random between the membranes and the uterine wall, after the method of Schweighauser and Cohen, and as is now so common- ly done, there is some liability of effecting an unfavorable change in the presentation of the child, and of inducing haemorrhage by partial separation of the placenta. It is also possible, as in two cases late- ly related by Simpson^ that rupture of the uterus, from excessive overdistension, may thus be produced. These remarks, however, do • American Journal of the Medical Sciences, April, 1829, p. 285. t I niiRlit refer to various otlicr points, of practical importance in this connection, but pre- fer to leave them ni the hands of an intelligent and tiilented Rentleman of the prcsent medi- cal clnss, Mr. Greene, of Fitcliburg, who is preparing a mouoKraph upon the subject. J Edinburgh Medical Journal, Sept., 1861, p. 290.
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