A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman.
- William Leishman
- Date:
- 1875
Licence: Public Domain Mark
Credit: A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
739/824 page 723
![it on an inflamed surface of the mucous membrane of the descending colon. This diphtheritic formation varies from a mere film to a thick, tough, tenacious false membrane. The parts upon which it appears sometimes ulcerate rapidly, as though the membrane had an erosive or dissolving action on the tissues. In from two to ten days the diph- theritic formation separates, leaving an ulcer which heals slowly by granulations if the disease is not fatal. Diphtheritic deposit may make its appearance on wounds of the genital organs before the initial chill or rigor occurs, but in these cases it is associated with shrinking of the features, pallor of the face, pelvic pain, and swelling of the uterus. The false membrane which has been described is, without doubt, diphtheritic in its nature. Prof. Lusk, who witnessed an outbreak of this disease at Bellevue Hospital, in New York, says that Dr. Steurer, who was one of his internes during the epidemic, has recently studied the microscopical appearances of this membrane in connection with Prof. Aon Recklinghausen, of Strasburg. Dr. Steurer says, We found it a true diphtheria. Micrococci were found beneath the deposit and scattered throughout the tissues of the uterus, whence they were taken up by the sinuses, and conveyed into the circulatory system. They maybe found in the muscular structure of the vulva, and always occur in colonies. They are sometimes found in the bloodvessels of the kidney, distending whole glomeruli. The lochia may be diminished or entirely suppressed. When per- sistent they may be more or less offensive. The uterus becomes en- larged. This appears to be due to swelling rather than relaxation. The enlargement may be so great that it is difficult to believe that the organ is empty. This symptom appears with the pelvic pain, and may precede the chill or rigor. Inflammation of the joints must be noted among the local symptoms. This may come on any time from the third to the twelfth day. Any of the joints may be affected. The process i- identical in its nature with that which occurs in surgical pyaemia. The most important results of the disease are inflammatory indura- tions and purulent accumulations in the pelvic and abdominal cavities. These are detected after the acute symptoms have disappeared, by com- bined vaginal and abdominal examination. The abscesses may open into the vagina, bowel, or through tin1 abdominal wall, and they some- times give exit to enormous accumulations of pus. Diagnosis.—This is not difficult. The presence of a diphtheritic false membrane on an injured surface of the genital tract Beta all doubts at rest. Prognosis, -This should be guarded. The establishment of marked morning remission- of temperature is a favorable Bign. Kail of tem- perature without corresponding favorable changes in the pulse, respira- tions, and appearance of the patient, presages death, < H.stinate diar- rhoea is an unfavorable symptom. Pathological Anatomy, if death occurs during the early Btages of the disease, injured surfaces and adjoining parts of the genital organs are found covered with the di] htheritic false nienil'iaue which has](https://iiif.wellcomecollection.org/image/b21016112_0739.jp2/full/800%2C/0/default.jpg)
