Report on the progress of practical medicine, in the departments of midwifery and the diseases of women and children in the years 1845-6 / by Charles West.

  • Charles West
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in the departments of midwifery and the diseases of women and children in the years 1845-6 / by Charles West. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    currence, the survival of a child for two hours after it had been extracted by means of Levret’s tire tete, and quite a fourth of the brain had escaped during the operation. [It must be borne in mind that the instrument em- ployed is a branched crotchet, which is applied without previous perforation of the skull.] Ccesarean section* Four cases are related of the performance of this ope- ration, with a favorable result both to mother and to child; 2 in which the mother survived, 6 in which the life of the child was preserved, and 2 in which neither life was saved. The history of the mother, in Mr. Goodman’s case is not carried beyond the third week, at which time, however, she was doing well. In the patient on whom Dr. Meyer operated, the uterus contracted around the neck of the child so firmly after the body was extracted, as to render it necessary to enlarge the incision, an accident which illustrates the advantage of extracting the head first whenever that is possible. Mr. Lyon’s case presents many points of interest. The operation was rendered necessary by the presence of a tumour blocking up the pelvis, and which, from its position behind the rectum, as well as from its firmness, was taken for an osteosteatomatous tumour of the pelvis. It turned out, however, to be the left ovary, enlarged and converted for the most part into an adipocire-like substance. [The case derives great importance from being almost, if not quite, the only instance of an ovarian tumour getting behind the rectum, and it illustrates the necessity of making an experimental puncture or incision of such tumours through the vagina, before exposing a patient]to the dangers of the Caesarean section.] In the case reported by Mr. Aitken, the uterus had given way before the patient’s admission into the hospital, so that the Caesarean section, which the extreme contraction of the pelvis rendered ne- cessary, could not be regarded as the sole cause of her death. [The statistics of the operation at present yield the following results. It has been performed in 378 cases, of which trustworthy accounts have been given. In 145 of these cases the women recovered, in 233 they died; or the recoveries were in the proportion of 38 per cent., or as one in 2 6 cases. The fate of 318 children is mentioned, of whom 219 were saved, 99 were lost, or the child survived in 68 per cent., or in rather more than 2 cases out of 3.] UTERINE HEMORRHAGE. Professor Simpsont has published some remarks on the anatomical source and pathological nature of post-partum hemorrhage, which have a direct and very obvious bearing on the opinion he has expressed with reference to the source of the hemorrhage in placenta praevia, and the treatment applicable to some cases of it. He notices the fact that hemorrhage sometimes takes place after delivery, notwithstanding the existence of an average amount of uterine con- traction, while, on the other hand, hemorrhage does not always follow the expulsion of the placenta, though the uterus is imperfectly contracted. Bleeding is prevented, not merely by the degree, hut also by the equability and uniformity of the uterine contraction, while other means besides mus- cular contraction concur in producing the same effects. Hemorrhage from the detachment of the placenta is never arterial, but always takes place from the veins; the blood that ought to flow onwards towards the periphery of the • Both lives saved—Dittmar, Gaz. Mdd. de Strasbourg, and Dublin Journal, Nov., 1845 ; Long, Gaz. Med., Sept. 13, 1845; Kiinsemtiller, Neue Zeitschr. f. Geburtsk., xix, p. 384; Steinbrenner, Gaz. des IlOpitaux, Sept. 12, 1846. Mother survived—Goodman. Med. Gaz., Dec. 26, 1845; Meyer, Med. Zeitung, Sept. 10, 17, 1845. Child survived—Lyon, Monthly Journal, Dec., 1845; Jungmann, two cases, Oesterr. Med. Jahrb., Sept., 1845 ; KirchoffVr, Neue Zeitschr. f. Geburtsk., xix, 3tes Heft; Balfour, Northern Journal, May, 1846; Aitken, Lancet, June 13, 1846. The last two cases occurred at Vienna, and are merely reported by Messrs. Balfour and Aitken. Neither life saved—KUnsemMler, *oc’i Northern Journal, January, 1846.