CONTRIBUTIONS TO THE PRACTICE OF MIDWIFERY. JiY P. S. MOOTOOSAWMY MOODELLY, U.M.MU., Native Surgeon, Civil Dispensary, Manargudy, Tanjore District. LABOUR
COMPLICATED WITH PROCIDENTIA UTERI.
Soornam, aged about 35, a tall delicate-looking woman of the labouring class, of brown complexion, and a native of this place, was brought to the hospital at 10 o'clock on the night of the 3rd December, 1866, in labour of her eighth child. Of the previous seven children only three are living, two boys and a girl?the latter being the youngest, and now three years old. 'Ihe labour pains, which are reported to have set in four days ago, and to have been strong at the commencement, are The membranes now weak and coming on at long intervals. ruptured at 8 o'clock last night. Pulse 140, small, quick; tongue thickly coated, moist; thirst urgent; bowels coustipated. No motion "for the last four days ; constant inclination to micturate, but the urine is passed in very small quantities at
time. On examination the abdomen is found hot; uterine tumour large; bladder distended ; uterus prolapsed, and hanging without the vulva; passages hot. but moist; head presenting very low in the sacrum, and impacted. Auscultation affords The midwives in attendance, four no indication of foetal life. of them, state that the head has made no advance from its present position since 9 o'clock this morning. Patient states that the uterine prolapse first occurred about three months after the birth of her first child, Avhile she was in the act of lifting a heavy load, and that she has suffered much from the protrusion ever since, particularly in the lust month of her pregnancy, when she is obliged to keep her bed from sheer inability to move about. In this state she has given birth to three living children ; she states that the prolapsus having increased since her last confinement, she is apprehensive of danger on this occasion. An enema of castor-oil and turpentine was administered, with the effect of producing one scanty evacuation, and an attempt to pass the catheter was made, but it failed from the I then amount of pressure exerted on the neck of the bladder. endeavoured to deliver by the short forceps, but the effort for woman as relief the from eagerly importuned failed; and her sufferings, I resolved on delivery by craniotomy. were first of and the clilorodyne head given, Thirty drops then perforated. After the reduction of its bulk, the crotchet was used, but unsuccessfully ; and the delivery was completed with difficulty by craniotomy forceps, the difficulty being due to the strong ossification of the cranial bones. A discharge of very offensive fluid followed the extraction of the foetus, which was a male, and of the ordinary size. The patient having become very weak during the operation, required to be supported by stimulants, &c., and the removal cf the placenta became necessary. The uterus was then returned, and retained in its place by a ball of tow enveloped in silk and secured by a T. bandage. The abdominal binder was then applied, and the patient di-essed and mads comfortable; she complained much of after-pains and thirst; pulse 130. 1? Calomel gr. iiss. :. Opii gr. i. Ant: tart: gr. gth. Ft. pil. s.s. 4 th.?Slept tolerably; pulse 126; made water once ; bowels still torpid ; complains of tenderness in the uterine region ; the uterus is kept in its place ; wishes to have some food To have
a
...
...
...
...
arrowroot, pint one, immediately ; an oily enema at 12 noon. 5th?Pulse 120; slept pretty well; the uterine pain has
been severe since last night ; bowels moved four times ; the motions "were scybalous and offensive ; lochia free.
THE INDIAN MEDICAL GAZETTE.
46 Calomel
Opii
Anc: every four hours.
gr. iiss. gr. ss. gr. |. M.
...
tart
:
ft.
pil.
abdomen ; low diet. since last night; has had several scanty motions, streaked with blood and slime, attended with griping and straining; the uterus prolapsed ; it was replaced and retained in position by an oval pessary; lochial continues free. Omit calomel.
Apply turpentine fomentations to the lower 6t/i.?Complains of dysenteric symptoms
discharge Ijt
01: ricini 01: terebinth : purificat Tinct: hyosciami Aquae cinnamomi ...
...
...
J},
Argent. Opii Ipecac:
???
...
m ...
nitrat: ...
...
?ss.
jij.
...
M. ft. pil. at 4 p.m., and at bed-time. Continue turpentine fomentations; to be
xx.
3iss.
M. ss.
gr. i gr. ? gr. i.
kept
in recumbent
position.
7 th.?Feels better; oil acted four times; had two motions
during the night; much the same as last report. Griping and straining are much easier; lochial discharge free, but is of puriform character. The uterus diminished in size, and is in The mammary organs are distended and painful. its place. Continue the astringent pills morning and evening. Omit turpentine fomentations. Apply poppy fomentations to the breast twice a day, and linseed poultice. Syringe tepid water into the vagina. 8th.?Improving ; pulse 95 ; lookingjbetter; the dysenteric and mammary symptoms subsided; tongue cleaning ; uterus not subsided since last report; bowels regular, motions feculent; lochia stopped; expresses a wish for curry and rice. Continue astringent pill at bed-time every night. To have rice and weak mutton broth for her dinner. Continue recumbent position. 12th.?Doing well, and wishes to leave the hospital. She some was advised to continue time longer in the recumbent position. Omit medicine. 19 th.?Quite well; anxious to return to her home. Discharged. Remarks.
good illustration of procidentia uteri aggravated by neglect and mismanagement I have no doubt that the woman would have had a good delivery, had relief being sought in time, and some attention been given to her bowels ; the constipated condition of which must have materially This
case
affords
a
As it was, her friends did not resort increased her distress to the hospital until twenty-four hours after the evacuation of the liquor amnii, and the parts concerned in parturition were in a condition bordering on the inflammatory Some time previous to the occurrence of the case just recorded, an almost parallel one came under my notice in which the The subject of it, woman was delivered of a living child. a wealthy native female from a neighbouring taluq, who had come to this place for her accouchement, was in a weak and emaciated state, and had been in labour of her fifth child, three days before I was asked to see her; I found her in a state of exhaustion, with the uterus prolapsed, the labour pains very feeble and ineffective, and the membranes entire. A grain of opium was administered, which produced some sleep; soon afterwards the pains increased somewhat, and she was delivered of a puny male child, which had scarcely the power to cry. Under the use of resuscitating measures, artificial respiration among them, the child seemed to improve, but lived only three days. The uterus was replaced, and measures adopted to secure it in position ; the patient is now doing well. In this case the uterine displacement occurred during the woman's second confinement, since which her general health has been very bad. She has two grown up boys and a girl living. I am induced to send these cases for publication, as they serve to show that much suffering and distress might be saved by timely application for relief; and because I find few or no cases of a similar nature recorded in our Indian medical journals.
[February 1, 1867.
COMPLICATED WITH PROCIDENTIA UTERI.
Soornam, aged about 35, a tall delicate-looking woman of the labouring class, of brown complexion, and a native of this place, was brought to the hospital at 10 o'clock on the night of the 3rd December, 1866, in labour of her eighth child. Of the previous seven children only three are living, two boys and a girl?the latter being the youngest, and now three years old. 'Ihe labour pains, which are reported to have set in four days ago, and to have been strong at the commencement, are The membranes now weak and coming on at long intervals. ruptured at 8 o'clock last night. Pulse 140, small, quick; tongue thickly coated, moist; thirst urgent; bowels coustipated. No motion "for the last four days ; constant inclination to micturate, but the urine is passed in very small quantities at
time. On examination the abdomen is found hot; uterine tumour large; bladder distended ; uterus prolapsed, and hanging without the vulva; passages hot. but moist; head presenting very low in the sacrum, and impacted. Auscultation affords The midwives in attendance, four no indication of foetal life. of them, state that the head has made no advance from its present position since 9 o'clock this morning. Patient states that the uterine prolapse first occurred about three months after the birth of her first child, Avhile she was in the act of lifting a heavy load, and that she has suffered much from the protrusion ever since, particularly in the lust month of her pregnancy, when she is obliged to keep her bed from sheer inability to move about. In this state she has given birth to three living children ; she states that the prolapsus having increased since her last confinement, she is apprehensive of danger on this occasion. An enema of castor-oil and turpentine was administered, with the effect of producing one scanty evacuation, and an attempt to pass the catheter was made, but it failed from the I then amount of pressure exerted on the neck of the bladder. endeavoured to deliver by the short forceps, but the effort for woman as relief the from eagerly importuned failed; and her sufferings, I resolved on delivery by craniotomy. were first of and the clilorodyne head given, Thirty drops then perforated. After the reduction of its bulk, the crotchet was used, but unsuccessfully ; and the delivery was completed with difficulty by craniotomy forceps, the difficulty being due to the strong ossification of the cranial bones. A discharge of very offensive fluid followed the extraction of the foetus, which was a male, and of the ordinary size. The patient having become very weak during the operation, required to be supported by stimulants, &c., and the removal cf the placenta became necessary. The uterus was then returned, and retained in its place by a ball of tow enveloped in silk and secured by a T. bandage. The abdominal binder was then applied, and the patient di-essed and mads comfortable; she complained much of after-pains and thirst; pulse 130. 1? Calomel gr. iiss. :. Opii gr. i. Ant: tart: gr. gth. Ft. pil. s.s. 4 th.?Slept tolerably; pulse 126; made water once ; bowels still torpid ; complains of tenderness in the uterine region ; the uterus is kept in its place ; wishes to have some food To have
a
...
...
...
...
arrowroot, pint one, immediately ; an oily enema at 12 noon. 5th?Pulse 120; slept pretty well; the uterine pain has
been severe since last night ; bowels moved four times ; the motions "were scybalous and offensive ; lochia free.
THE INDIAN MEDICAL GAZETTE.
46 Calomel
Opii
Anc: every four hours.
gr. iiss. gr. ss. gr. |. M.
...
tart
:
ft.
pil.
abdomen ; low diet. since last night; has had several scanty motions, streaked with blood and slime, attended with griping and straining; the uterus prolapsed ; it was replaced and retained in position by an oval pessary; lochial continues free. Omit calomel.
Apply turpentine fomentations to the lower 6t/i.?Complains of dysenteric symptoms
discharge Ijt
01: ricini 01: terebinth : purificat Tinct: hyosciami Aquae cinnamomi ...
...
...
J},
Argent. Opii Ipecac:
???
...
m ...
nitrat: ...
...
?ss.
jij.
...
M. ft. pil. at 4 p.m., and at bed-time. Continue turpentine fomentations; to be
xx.
3iss.
M. ss.
gr. i gr. ? gr. i.
kept
in recumbent
position.
7 th.?Feels better; oil acted four times; had two motions
during the night; much the same as last report. Griping and straining are much easier; lochial discharge free, but is of puriform character. The uterus diminished in size, and is in The mammary organs are distended and painful. its place. Continue the astringent pills morning and evening. Omit turpentine fomentations. Apply poppy fomentations to the breast twice a day, and linseed poultice. Syringe tepid water into the vagina. 8th.?Improving ; pulse 95 ; lookingjbetter; the dysenteric and mammary symptoms subsided; tongue cleaning ; uterus not subsided since last report; bowels regular, motions feculent; lochia stopped; expresses a wish for curry and rice. Continue astringent pill at bed-time every night. To have rice and weak mutton broth for her dinner. Continue recumbent position. 12th.?Doing well, and wishes to leave the hospital. She some was advised to continue time longer in the recumbent position. Omit medicine. 19 th.?Quite well; anxious to return to her home. Discharged. Remarks.
good illustration of procidentia uteri aggravated by neglect and mismanagement I have no doubt that the woman would have had a good delivery, had relief being sought in time, and some attention been given to her bowels ; the constipated condition of which must have materially This
case
affords
a
As it was, her friends did not resort increased her distress to the hospital until twenty-four hours after the evacuation of the liquor amnii, and the parts concerned in parturition were in a condition bordering on the inflammatory Some time previous to the occurrence of the case just recorded, an almost parallel one came under my notice in which the The subject of it, woman was delivered of a living child. a wealthy native female from a neighbouring taluq, who had come to this place for her accouchement, was in a weak and emaciated state, and had been in labour of her fifth child, three days before I was asked to see her; I found her in a state of exhaustion, with the uterus prolapsed, the labour pains very feeble and ineffective, and the membranes entire. A grain of opium was administered, which produced some sleep; soon afterwards the pains increased somewhat, and she was delivered of a puny male child, which had scarcely the power to cry. Under the use of resuscitating measures, artificial respiration among them, the child seemed to improve, but lived only three days. The uterus was replaced, and measures adopted to secure it in position ; the patient is now doing well. In this case the uterine displacement occurred during the woman's second confinement, since which her general health has been very bad. She has two grown up boys and a girl living. I am induced to send these cases for publication, as they serve to show that much suffering and distress might be saved by timely application for relief; and because I find few or no cases of a similar nature recorded in our Indian medical journals.
[February 1, 1867.
