Laparo-hysterotomy : its indications and technique / by N. Senn.

  • Nicholas Senn
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Laparo-hysterotomy : its indications and technique / by N. Senn. 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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    Case I.—Patient, twenty-four years of age, German parentage, born in this country. First child delivered by version and craniotomy two years before her second pregnancy. The attending physicians made a careful examination of the pelvis and found it flattened and contracted to such an extent that they gave it as their opinion that she could never be delivered of a mature living child through the normal passage. The delivery was followed by thrombo-phlebitis and septic infection, which nearly proved fatal, and only yielded to thorough intra-uterine anti- septic irrigations. When she became pregnant the second time, her attending physician, Dr. Wenzel, advised her to enter the Milwaukee Hospital a few days before the expected labor, for the purpose of mak- ing the necessary preparations for a laparo-hysterotomy. This advice was eagerly accepted. Labor commenced 6.30 Christmas morning, 1890. The labor pains were regular and strong. The membranes rup- tured at 8 a.m. As, in spite of frequent and violent expulsive pains, the head had not entered the pelvis at 11 A.M., the operation was performed in the manner described above. The record states that the child was outside of the uterus in one minute after the operation commenced, and in ten minutes later the patient was put to bed. The hemorrhage was profuse for a moment, but was arrested by the pressure of the body of the child. The placenta was attached near to the uterine wound, and was removed without difficulty. A large piece of membrane was re- moved separately. During the suturing of the wound the hemorrhage was controlled completely by the elastic constrictor. The child weighed ten and a half pounds. With the exception of a slight post-partum temperature the mother made a good recovery. Abdominal incision healed by primary intention. Mother and child living and in good health at the present time. Case II.—Woman, twenty-eight years old, native of Munich, where she resided until one year ago. Married four years. First became pregnant three years ago. After being in labor for two days a forceps delivery was attempted, but failed. An assistant of Professor Winckel was called in, who performed craniotomy. He informed the patient at that time that in the event she should become pregnant again, premature labor should be induced not beyond the thirtieth week, as the pelvis was not sufficiently large to permit the delivery of a full-grown living child. Soon after coming to Chicago she became pregnant a second time, and allowed gestation to progress to full term. She was attended by Dr. Broell, attending obstetrician to St. Joseph’s Hospital, who, upon ex- amination, corroborated the statement previously made to her, that the pelvic capacity was such as to render the passage of the child impossible without resort to a mutilating operation on the child. She had been in labor for fifteen hours when she was admitted into St. Joseph’s Hospital, October 1, 1892. Although the labor pains had been regular and strong, the head had not entered the pelvis. The patient was prepared at once for the operation. The abdominal wall in the middle line was exceedingly thin. The operation was performed very quickly, the patient being under the influence of chloroform, and a large living child delivered. The placenta was nearly separated as soon as the uterus was brought out from the abdominal incision. The uterus contracted firmly immediately after the delivery of the child. The uterus was constricted below the wound as soon as it was brought out of the abdomen, and the amount of blood lost during the entire operation did not exceed that of
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