Volume 2

Note on the stethoscopic examination of the pregnant uterus / [Andrew Anderson].

  • Anderson, Andrew, 1818-1870.
Date:
1844]
Catalogue details

Licence: Public Domain Mark

Credit: Note on the stethoscopic examination of the pregnant uterus / [Andrew Anderson]. Source: Wellcome Collection.

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    s thors on the comparative frequency of the two positions of the occiput. In three cases of face presentation, where the chin was turned to the left acetabulum, and which in fact are cases of Nsegele’s second { ’ position, in which rotation has not taken place, and in which the head has been thrown back on the shoulders, the sounds were ^ heard to the left side, higher up than usual, and very loud. The reason is obvious: had it been an occipital presentation, the maxi¬ mum would have been to the right side, the child’s back being forced into contact with the uterus there; but as the head is in a face presentation thrown back, the consequence is that the back of the child is separated by liquor amnii from the uterus, and its breast forced against the left wall; therefore the sounds are heard over that region, and they are much clearer here than in any other case, because we place the stethoscope immediately over the region of the heart. Thus also in another case, where the face presented, while the brow was felt towards the left acetabulum, the heart’s ac¬ tion was heard to the right side. It may, however, be remarked in passing, that the beat of an infant’s heart is audible over most of its body; if the stethoscope be placed on the thigh of a new-born child, it is distinctly heard. 4. If a careful examination be made of the belly by the hand, the position of the child can thus be discovered in most cases,—in 60, as I have found, out of 88; and indeed we can frequently tell whether it be a first or a second position, by simply asking the mother on which side she feels the child’s motions most lively; in 46 out of 73 cases, she fixed upon that side towards which the front of the foetus was turned. 5. I am persuaded that if attention were paid to the matter, the presence of twins might almost always be detected by the stetho¬ scope. I had an opportunity of examining four cases, and in two made the diagnosis of twins, from hearing two maxima separated by very weak sounds; in the third case, examined before I began to pay particular attention to the matter, the diagnosis was not made, but it was remarked as curious, that the sounds were audible on both sides; in the fourth, there was only one maximum, but one of the foetuses had been for some time dead. In the first case, one maxi¬ mum was high up on the right, and the other low on the left side; a head presented first, then retrograded, and the children were born as in the first case. In the fourth case, the maximum was high up on the right; both children presented the head, but the dead one ^was born first. In the first case, the two hearts beat with equal rapidity,—from 140 to 160; in the second, the pulsations to the right were 140 to 148; those on the left, 164 to 172 in a minute; and when a day old, the infants presented a like difference in the rapidity of the heart’s action, the pulse being in the child which had presented the breech 108 ; in the other, 136. 6. It is incorrect to state, as has been done, that numbers such
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