On surgical diseases of women / by I. Baker Brown.

  • Isaac Baker Brown
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: On surgical diseases of women / by I. Baker Brown. Source: Wellcome Collection.

    169/468 (page 119)
    operation has, therefore, not been entirely satisfactory, and we have heard this gentleman state that, although it is almost invariably successful, yet some- times cases do present themselves, as the one just referred to, in which it does not prove so favourable as might be anticipated. Case XI.—Prolapsus uteri complete,: eight years' duration: with Cystocele: Cure.—Emma H., set. 37, was admitted into St. Mary's Hospital on May 1st, 1856. Sixteen years ago, she first began to complain of bearing down ; this was after giving birth to her second child. For eight years she suffered from leucorrhoea, menorrhagia, and increased bearing down ; and at the end of this period she first observed that the womb began to protrude from the vulva. The uterus has since that time fallen further out of the pelvis, until at last it formed a tumour between the thighs as large as a child's head, according to the patient's account. The discharge has increased with the prolapse ; mictu- rition is impeded when the uterus is down ; she suffers very much from dragging pains. She is a laundress by occupation, and is unable to perform the work. Her general health is pretty good. She can return the uterus easily. Has never worn any instrument, and has never had any medical or surgical advice for her complaint. She has been in her present condition for the last three years. Menstruation is now scanty, and not quite so regular as formerly. On examination, the os externum is found to be dilated into a huge pouch, through which the uterus and bladder protrude. The os uteri is very much excoriated, and presents an ulcerated zone around the orifice. The epithelium of the vagina is very much hypertrophied, and is rough and scaly. May 7th. I performed my usual operation. May 10th. Deep sutures removed. May 17th. Superficial sutures removed ; parts quite healed. The operation has been quite successful in every way. June 17th. Discharged perfectly cured. Case XII.—Prolapsus uteri complete, with Cystocele and ruptured perinaium: fours years'1 duration: Cure.—Esther C, eet. 50, married, admitted into St. Mary's Hospital May 17th, 1856. Four years ago she was delivered of her tenth child : she described it as a tedious labour, lasting from three o'clock in the morning till seven at night; she was attended by a woman ; it was a cross- birth, and the child was still-born. The womb protruded through the vagina, which so disconcerted the midwife that she sent for a medical man, who placed the patient on her knees, and pushed back the womb ; he had also to detach the placenta. Whether this was done before the reduction of the protruded womb or not, the patient is not; certain, but there was considerable haemor- rhage after the child was born. Since that time she has been unable to follow her occupation as a charwoman, and can work at no employment unless in the sitting posture. The catamenia have been quite regular up to the present time; she has suffered from a dark yellow discharge for the last twelve months. The uterus began to prolapse on getting about after her confinement, and has gradually increased. When confined of her first child she ruptured her peri- nseum up to the sphincter, but not through the muscle ; consequently she has never had a full perinaeum. Present condition.—Middle stature, of well-developed muscular frame. The uterus constantly protrudes, even in the recumbent posture, but can be returned by manipulation. It is rough and scaly, the epithelium being har- dened. She cannot micturate when the uterus is down, having to push it up to do so, as well as the bladder, which is also prolapsed. The uterus when down is the size of a swan's egg, and the os is excoriated. The cicatrix of the