Carolina Bechang, was admitted into Graefe's Clinicum, in an advanced stage of pregnancy; being 30 years of age, much deformed by rickets, and only four feet (Rhenish) in height. On the 20th of Sept. after having been five days in labour at the full period, pains severe, and os uteri dilated, she consented to the Cæsarian section.
A little after 2 o'clock, Graefe placed the fore finger of his left hand, immediately below the umbilicus, and with a large scalpel, made an incision downwards in the linea alba, to within one inch of the pubis; dividing the entire parietes, and even penetrating the substance of the uterus. A second incision penetrated the uterus and exposed the placenta; which, as had been anticipated, was found on the fore part of the fundus. The assistants now compressed firmly the edges of the divided abdominal parietes upon the uterus, to prevent the protrusion of the intestines, in which they succeeded; and Graefe carried his hand in a moment into the uterus, separated the placenta with his finger and thumb, and then withdrew it and the child almost together. The child was very active, and cried lustily. The uterus immediately and suddenly contracted, and the bleeding was inconsiderable. Not more than twelve ounces of blood were lost, and no ligature was required. The whole operation was completed in four minutes and a half. The wound was secured by three broad sutures, and adhesive plasters, assisted by a bandage round the abdomen. The child weighed six pounds and was well formed. During the operation, the patient was sick, and once vomited slightly. In two hours had pain and fever: V.S. ℥xij. Draught with ten drops of the aqua laurocerasi was given, and repeated in a few hours. The patient passed a quiet night. The symptoms of pain, inflammation, and fever, were threatening for some days, and were promptly resisted by the lancet, by enamata, by narcotics, especially the laurocerasus and hyosciamus, by fomentations, &c. By the 9th day, the wound had cicatrized, excepting near the symphisis; symptoms all favourable. The lochia were discharged regularly; and in three weeks, she was able to sit up, and in three more, quite well. Early in November, she returned home with her child, both in perfect health.
In Ferussac's Bulletin Universel; for February, another case, in which the Cæsarian operation was performed with safety to the mother and infant, is copied from Rust's Magazine.
61. Extirpation of the Uterus.—Dr. Rheineck, of Memmingen, was consulted by a female, who in December, 1824, was attacked by fever, from which she slowly recovered. A prolapsus of the uterus, which gradually became inverted, followed, attended with frequent hæmorrhage and discharge, by which she was almost worn to the grave. The whole of the uterus was inverted, and without the labia externa; its surface loose, fungous, and in several places easily broken down upon pressure; but there was no hardening nor ulceration. The irritation was so great, as to threaten the patient's life, and after a consultation, in which it was agreed, that the swelling was really formed by the uterus, the tumour was laid hold of and drawn forwards, and a broad ligature, secured with a double surgeon's knot, was applied round its base. In about three weeks, the whole had separated, and the part above the ligature was cicatrized. During this period, the patient was dangerously ill, and was only rescued by great care and attention.
The operator had before performed a similar operation, in which case, the patient died suddenly from hæmorrhage, on the separation of the ligature. Osiander, Struve, Longenback, Sauter, Siebold, and Zaug, have in late years performed the same operation, with various degrees of success.—Johnson's Review for April, 1826, who quotes from Siebold's Journal fur Geburtshulfe, 1826.
62. Uterine Hæmorrhage.—In the Bulletin Universel for Jan. 1826, the following case is detailed from the Gazette de Santé, for Dec. 1825.
A female aged 32 years, was taken with labour with her first child, on the 12th Feb. 1825. The pains soon ceased, and on the 15th of Feb. M. Bedel, physician at Schirmack, was consulted, who speedily delivered her, by means of the forceps, of a dead child. The hæmorrhage was so considerable, as to render the immediate removal of the placenta necessary; but the uterus did not contract, and the bleeding continued, with tremblings, syncope, cold sweats, &c. Irritation on the internal surface of the uterus, the use of cold water to the abdomen, injections into the uterus of cold water and vinegar, were unavailing.
Plugging the vagina, and also the uterus, was now resorted to, as the only means of safety remaining. The uterus was filled with pieces of rags, for fear the patient could not sustain the loss of blood necessary to fill that cavity; while a methodic compression was at the same time made to the abdomen. The hæmorrhage was immediately arrested, and soon after reaction ensued.
On the 16th, M. Bedel extracted the plugs from the uterus, cautiously and in succession; and had the pleasure of finding the uterus regularly contracting after each removal. The lochial discharge continued, and there was no secretion of milk. The patient recovered slowly.
It is in such cases as the above, that the physicians of the United States have employed the Secale Cornutum (Ergot,) the judicious use of which would have probably superseded the necessity of instruments, and prevented or arrested the hæmorrhagic discharge.