CONTRIBUTION TO THE PRACTICE OF MIDWIFERY. By P. S. Mootoosamy, G. M. S., F. L. S., Fellow of the
Obstetrical Society of London. burgeon, 67tv7 Dispensary and Lying-in-Hospital {superintendent, Local Fund 3Iidwifery School, Mannargoodi, Tanjore District.
JVative
/Case
'
No. 1?Protracted labour: Head-large: BladDISTENDED : YULVA AND PERINEUM MUCH swollen : Delivery by Craniotomy : Sloughing of Labia Majora and atony op Bladder after deliveDER
ry
:
Recovery.
A woman of about 35 years of age, in labour of her fifth child, was brought into hospital on the 20th June 1879. She was of short stature, dark complexion, and of good conformation. Her previous confinements were said to have been easy ; and her four children, two male and two female, are now
living.
The pains, described as weak and inefficient, are said to have commenced on the 16th June, or five days before she was brought to the dispensary, and to have continued until the rupture of the membranes, which took place 34 hours previous to admission, since which they quite ceased. No action of the bowels had occurred for six days, and the urine involuntarily escaped in small quantities. The skin was hot, pulse full, tongue thickly coated, and thirst was urgent. On examination the abdominal tumour was found large and prominent ; the bladder very much distended ; vulva and perimeum considerably swollen : the former presenting a tense shiny appearance. The passages were hot, dry and tender. The head presented, and was firmly impacted in the hollow of the sacrum ; auscultation gave no indication of foetal life.
July
A MIRROR OP HOSPITAL PRACTICE.
1, 1880.]
Tho distension of the bladder was relieved by a gum elastic catheter, and an ineffectual attempt was made to free the bowels by enema. Craniotomy was then resorted to ; but owing to the dryness of the passages, and the unusually large size of the child, difficulty was experienced at every step of the operation. The placenta was expelled, but the uterus failed to contract until after the exhibition of ergot, brandy and opium, and the employment of pressure and cold. Compresses and an abdominal bandage were then applied. The patient slept for some time, and was awakened by after-pains, which were so severe that the following were administered with the effect of allaying them :? Tinct. Valerian. Ammon. Liqr. Opii Sedativ. Spts. .ZEtheris Nit.
Aquas Camphoraa
m XXX.
...
...
?
...
?
xv.
xxx.
Jiss.
...
m.
For three days the functions of the bladder were suspended, and the urine had to be withdrawn. Sloughing of the labia majora took place, and was treated by the application of poultices and carbolic oil. Subsequently the patient suffered from dysentery, which however speedily yielded to treatment. Remarks.?This is another instance in which the mischievous meddling of uneducated native midwives was attended with almost fatal results. The difficulty at first was no doubt due in a great measure to the unusually large size of the child's head, all the subsequent complications were traceable to the rude, violent and prolonged efforts of the midwife to accomplish delivery. The enormous tension and swelling of the vulva and perinaeum, the dryness of the passages, and the subsequent sloughing of the labia majora were clearly the and ill-directed exeroutcome of the midwife's vigorous tions. the resided within two miles of In this case patient the hospital, and yet it was not until the fifth day of her labour, and until all hope of obtaining relief at the hands of the midwife had been abandoned, that she was brought to hospital. Case tation ty
:
No. 2.?Preternatural :
Labour
:
Arm presen-
Turning accomplished with great
difficul-
Kecovery.
At 2 o'clock on the morning of the 2nd August 1879, I was called to see a woman in the town reported to be in labour of her second child. I found the patient, a young woman of delicate build and short stature, lying on a mat on the floor of a small ill-ventilated room, with a piece of cloth, barely siifficient for the purpose, thrown over her as a covering. Two native midwives, who were in attendance, informed me that the pains set in on the morning of the previous day, and that rupture of the membranes took place soon afterwards, when an arm protruded. They were compelled, they said, to advise my being called in, not that they had any doubt of their own ability to relieve the woman, but because she was unmanageable, and obstinately refused to submit to their operations any longer. found the left arm, cold and swollen, ?On examination I foetus occupying the second anterior-dorsal protruding, the position. The uterus was firmly contracted on the body of the child ; the vagina hot, dry and tender ; skin hot, pulse quick ; thirst extreme. I proceeded to deliver the child by turning, but met with much opposition from the poor woman, who desist, and allow her to die quietly. piteously urged me to She had undergone, she said, a great deal at the hands of the midwives, and she begged that she might be spared further I soothed her, and succeeded in persuading pain and trouble. to proceed with the operation. I found her to allow me was so firmly contracted on the body however that the uterus of the child that, small as my hand is, I was unable to pass it therefore desisted I and administered some into the uterus, brandy with tincture of opium, which procured for the hours' refreshing sleep. I then renewed patient about two and with much difficulty succeeded in seizing my attempt, of the feet: to this I fixed a running noose, and one brought it down. The remainder of the operation was happily got over without much difficulty. The child was a male, and still-born. The placenta was adherent and removed with Firm contraction of the uterus ensued, a some difficulty. were applied, and the brandy and opium compress and binder Excepting that^ some symptoms of inflamwere repeated. the on third day after delivery, the mation supervened woman
made
a
good
recovery,
187
Remarks.?This case also affords aiVther instance of the difficulties and dangers attendant on employing the indigenous class of midwives. I was called in barely in time to save the patient's life, which was placed in jeopardy by the rough and rude handling of ignorant women. These women had the effrontery to assure me that they had advised the patient's friends to send for me, not that they felt any want of confidence in themselves, or were unequal to their duties, but simply because the woman did not submit to their treatment That they had used violent so tamely as they could wish. efforts to extract the child is proved by the condition of the uterus and passages, and that in these efforts they did not pull off the protruding arm is surprising. I suppose the firm manner in which the uterus grasped the body of the child, and resisted their efforts, prevented this. That the patient should have suffered such a mild attack of uterine inflammation, and made a good recovery is also surprising..
7
Obstetrical Society of London. burgeon, 67tv7 Dispensary and Lying-in-Hospital {superintendent, Local Fund 3Iidwifery School, Mannargoodi, Tanjore District.
JVative
/Case
'
No. 1?Protracted labour: Head-large: BladDISTENDED : YULVA AND PERINEUM MUCH swollen : Delivery by Craniotomy : Sloughing of Labia Majora and atony op Bladder after deliveDER
ry
:
Recovery.
A woman of about 35 years of age, in labour of her fifth child, was brought into hospital on the 20th June 1879. She was of short stature, dark complexion, and of good conformation. Her previous confinements were said to have been easy ; and her four children, two male and two female, are now
living.
The pains, described as weak and inefficient, are said to have commenced on the 16th June, or five days before she was brought to the dispensary, and to have continued until the rupture of the membranes, which took place 34 hours previous to admission, since which they quite ceased. No action of the bowels had occurred for six days, and the urine involuntarily escaped in small quantities. The skin was hot, pulse full, tongue thickly coated, and thirst was urgent. On examination the abdominal tumour was found large and prominent ; the bladder very much distended ; vulva and perimeum considerably swollen : the former presenting a tense shiny appearance. The passages were hot, dry and tender. The head presented, and was firmly impacted in the hollow of the sacrum ; auscultation gave no indication of foetal life.
July
A MIRROR OP HOSPITAL PRACTICE.
1, 1880.]
Tho distension of the bladder was relieved by a gum elastic catheter, and an ineffectual attempt was made to free the bowels by enema. Craniotomy was then resorted to ; but owing to the dryness of the passages, and the unusually large size of the child, difficulty was experienced at every step of the operation. The placenta was expelled, but the uterus failed to contract until after the exhibition of ergot, brandy and opium, and the employment of pressure and cold. Compresses and an abdominal bandage were then applied. The patient slept for some time, and was awakened by after-pains, which were so severe that the following were administered with the effect of allaying them :? Tinct. Valerian. Ammon. Liqr. Opii Sedativ. Spts. .ZEtheris Nit.
Aquas Camphoraa
m XXX.
...
...
?
...
?
xv.
xxx.
Jiss.
...
m.
For three days the functions of the bladder were suspended, and the urine had to be withdrawn. Sloughing of the labia majora took place, and was treated by the application of poultices and carbolic oil. Subsequently the patient suffered from dysentery, which however speedily yielded to treatment. Remarks.?This is another instance in which the mischievous meddling of uneducated native midwives was attended with almost fatal results. The difficulty at first was no doubt due in a great measure to the unusually large size of the child's head, all the subsequent complications were traceable to the rude, violent and prolonged efforts of the midwife to accomplish delivery. The enormous tension and swelling of the vulva and perinaeum, the dryness of the passages, and the subsequent sloughing of the labia majora were clearly the and ill-directed exeroutcome of the midwife's vigorous tions. the resided within two miles of In this case patient the hospital, and yet it was not until the fifth day of her labour, and until all hope of obtaining relief at the hands of the midwife had been abandoned, that she was brought to hospital. Case tation ty
:
No. 2.?Preternatural :
Labour
:
Arm presen-
Turning accomplished with great
difficul-
Kecovery.
At 2 o'clock on the morning of the 2nd August 1879, I was called to see a woman in the town reported to be in labour of her second child. I found the patient, a young woman of delicate build and short stature, lying on a mat on the floor of a small ill-ventilated room, with a piece of cloth, barely siifficient for the purpose, thrown over her as a covering. Two native midwives, who were in attendance, informed me that the pains set in on the morning of the previous day, and that rupture of the membranes took place soon afterwards, when an arm protruded. They were compelled, they said, to advise my being called in, not that they had any doubt of their own ability to relieve the woman, but because she was unmanageable, and obstinately refused to submit to their operations any longer. found the left arm, cold and swollen, ?On examination I foetus occupying the second anterior-dorsal protruding, the position. The uterus was firmly contracted on the body of the child ; the vagina hot, dry and tender ; skin hot, pulse quick ; thirst extreme. I proceeded to deliver the child by turning, but met with much opposition from the poor woman, who desist, and allow her to die quietly. piteously urged me to She had undergone, she said, a great deal at the hands of the midwives, and she begged that she might be spared further I soothed her, and succeeded in persuading pain and trouble. to proceed with the operation. I found her to allow me was so firmly contracted on the body however that the uterus of the child that, small as my hand is, I was unable to pass it therefore desisted I and administered some into the uterus, brandy with tincture of opium, which procured for the hours' refreshing sleep. I then renewed patient about two and with much difficulty succeeded in seizing my attempt, of the feet: to this I fixed a running noose, and one brought it down. The remainder of the operation was happily got over without much difficulty. The child was a male, and still-born. The placenta was adherent and removed with Firm contraction of the uterus ensued, a some difficulty. were applied, and the brandy and opium compress and binder Excepting that^ some symptoms of inflamwere repeated. the on third day after delivery, the mation supervened woman
made
a
good
recovery,
187
Remarks.?This case also affords aiVther instance of the difficulties and dangers attendant on employing the indigenous class of midwives. I was called in barely in time to save the patient's life, which was placed in jeopardy by the rough and rude handling of ignorant women. These women had the effrontery to assure me that they had advised the patient's friends to send for me, not that they felt any want of confidence in themselves, or were unequal to their duties, but simply because the woman did not submit to their treatment That they had used violent so tamely as they could wish. efforts to extract the child is proved by the condition of the uterus and passages, and that in these efforts they did not pull off the protruding arm is surprising. I suppose the firm manner in which the uterus grasped the body of the child, and resisted their efforts, prevented this. That the patient should have suffered such a mild attack of uterine inflammation, and made a good recovery is also surprising..
7
