Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West.

  • West, Charles, 1816-1898.
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West. Source: Wellcome Collection.

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    large deposit of lithic acid, but it reappeared on the urine again becoming natural. From ten observations on pregnant women M. Kleybolte arrives at conclusions favorable to the importance of kysteine as a sign of pregnancy ; but he has not examined the urine of other persons, and is therefore unable to say whether it may not be formed independent of the existence of preg¬ nancy. A case is related by Mr. Barbieri,* in which many of the symptoms of preg¬ nancy occurred in a patient aged 32, who had already given birth to three children. At the supposed term of utero-gestation, the breasts being then full of milk, and the abdomen large and firm, pains conceived to be those of labour, came on. The results of percussion over the abdomen were rather contradictory, but the os and cervix uteri were quite unaltered, though the vagina was moist and relaxed, and the patient stated that the liquor amnii had been discharged. The pains, however, were less regular than those of labour, and symptoms of inflammation of some important viscus were thought by M. Barbieri to be present. For these the patient was treated very ener¬ getically, but she died on the twenty-first day. The uterus was found quite healthy and unaltered, but the peritoneum was thickened and vascular, and there was very great vascularity of the duodenum, ileum, and rectum, with ul¬ ceration of the last 12 inches of the ileum. Disorders of pregnancy. M. Chaillyf relates the particulars of three cases of vomiting during pregnancy, which proved fatal by its severity. In the first case the patient died in the 14th week of utero-gestation; and vomiting un¬ attended by fever had existed for three months. There was no lesion of the stomach, but “evident inflammation ” of the decidua. In the second case, death took place at the same period, and obstinate vomiting had existed from the very beginning of pregnancy. Very slight lesions were found in the sto¬ mach, but there was sanguineous engorgement of the decidua and of the uterine tissue, with softening and thickening of the uterine parietes. In the third case death took place at months, the patient being then in a state of complete marasmus, from vomiting which had existed for two months. Abortion. Dr. Bondi recommends the employment of a pair of forceps which he has invented to remove the placenta in those cases of abortion in which its retention occurs. His forceps are ten inches long, and resemble a pair of bullet forceps, much curved, and with very long blades. [The employment of mechanical means for removing the placenta in these cases is not new; and is generally discountenanced by those who have had the largest experience, on account of the impossibility of guiding any instrument introduced into the uterus during the early months of pregnancy.] Rupture of the uterus. Dr. Prael§ relates the case of a woman who be¬ came pregnant after having undergone the Caesarean section. At the 4th month of her second pregnancy a small ulcer formed on the right side of the abdomen, and gradually increased to the size of the hand. Near the end of pregnancy, but before labour had commenced, the uterus and abdominal in¬ teguments gave way in this situation, and the foetus with its membranes es¬ caped into the bed. The placenta was removed by the hand, the patient re¬ covered well, though the cicatrization of the rupture was not complete until after the lapse of ten weeks. A singular and unique case of fatal rupture of the vagina at the end of pregnancy, but before labour had commenced, is re¬ corded by Dr. Doherty.|| The patient in whom it occurred had a some¬ what contracted pelvis, and her vagina was in an unhealthy state as the result of the severity of her previous labour. Dr. Doherty supposes that * London and Edinb. Monthly Journal, March 1844. f Bull. Gen. de Therap. Oct. 30. 1844. t American Journal of Med. Science, April 1844. § Edinb. Med. Surg. Journal, April 1845; extracted from Allg. Repert. June 1844. || Dublin Hosp. Gazette, May 15, 1845.