(2) A long forceps delivery. Nistarini, Hindu female aged 40, primipara, admitted 011 16th May 1886. Patient was in labour, and said that the liquor amnii had been dribbling away for six days previously. On examination the parts were found very rigid, the conjugate diameter of the brim was contracted, and the os only admitted one finger. The foetal
heart sounds were audible, but weak. I incised and forcibly dilated the os, and then applied the forceps under chloroform. Intermittent traction was employed. After an hour there was some slight advance of the head, and the foetal heart was still heard. The chloroform was then stopped, and traction continued intermittently foranotherhour. Examined again, and found foetal heart still audible. As there was some advance of the head and the child still lived, and as I did not consider that I was justified in perforating, and expected the head every moment to be sufficiently moulded to pass the brim,I again continued traction for another hour. At the end of the third hour the head had been sufficiently moulded to pass the brim, but the foetal heart sounds became weak and fluttering. Very gentle traction was now employed, and the child was delivered by forceps after 3 hours and 20 minutes. The child died about 15 minutes There was some before completion of delivery. rupture of the perineum, which was extremely
% JUiipi of losspiM |P4tiq. EDEN
CALCUTTA.
HOSPITAL,
Cases reported by Surgeon R. J.
Offg.
Civil
Polden, Surgeon, Chittagong.
The following cases which occurred whilst I Resident at the Eden Hospital, Calcutta, present points of interest: ?was
?
(1) Case of persistent Hymen impeding the passage oj the head during labour. Mrs. J., European, admitted, 15th May 1886, in labour, primipara. Age 28. 1st stage, 19 hours; 2nd stage, 2 hours, 15 minutes. When the second stage had lasted for nearly two hours, the matron, who was conducting the case, sent for me, as it seemed to her that the vagina was so narrow as to impede delivery. I examined and found the pains good ; with each pain the scalp of the child protruded through a small opening 2in. long and fin. wide when distended ; this openiug was the central aperture in a very strong hymen, which completely encircled the orifice of the vagina. During an interval between the pains I lacerated this structure by introducing a finger at either side. After this, labour proceeded so quickly, that the perineum had not time for proper distension, and a slight rupture resulted. The rupture was sutured, and case
progressed favourably.
rigid.
The
woman
made
a
good
recovery,
110
fistulte
resulting.
Remarks.?If I
were called to see such a case I should be inclined to perforate think I again, much sooner; for the long application of the forceps endangers the mother, whilst the continued pressure and traction leave the child How much the foetus very little chance of life. can endure, however, is well illustrated by this case, for the child lived till the moulding of the head was all but completed; enduring these three hours' traction and pressure, after days of pressure by the contracting uterus.
(3) Dysenteric symptoms after delivery due round toorms?18 worms passed?Subsidence sympto?ns? Cancrvm oris.
ty
to
of
Luchman, Hindu female aged 28, 4th preguancy, admitted on 27th April 1886, and delivered of a living male child the same day. She was greatly emaciated and suffered from severe
dysentery,
which
yielded
to
none
of the usual
methods of treatment.
Three weeks after delivery she passed in two days 18 round worms after which the dysenteric symptoms subsided. To add to the poor creature's miseries and to hasten the end cancrum oris set in, and I was compelled to transfer the case. Remarks.?Thia case taught me a lesson which my subsequent large experience at the Eden Hospital fully confirmed, viz., that in Lower
ANTIPYRIN RASH.
Aug., 1887.]
Bengal when you have any disturbance of the digestive tract or the reflex phenomena arising therefrom, and when the usual treatment for dysentery, diarrhoea, convulsions, &c., fails, play
your trump card, santonin. Latterly, I very often began with the santonin, and in a good proportion of cases the result justified my action. It is true that almost every subject on the postmortem table shows one or more round worms in its intestines and possibly without any symptoms indicating their existence during life; but these worms become troublesome customers when they migrate and get into unusual places and so set up irritation. In this way we lost at the Hospital a fine healthy little boy from convulsions, caused by a round worm which was working up into the stomach and stuck at the pylorus: no doubt a dose of santonin would have saved his life.
(4) Two cases of supplementary mammce. (A.) Kokil, H. F., aged 25, admitted for the treatment of mammary abscess : 011 proceeding to dress the abscess, it was found that there two supplementary mammae, one at each
were
side the anterior folds of the axilla)?they were about the size of a hen's egg and the skin over them was dark, but there was 110 separate nipple. By inquiry it was found that the lumps were not congenital; but appeared in the third month of her first pregnancy and developed with the normal breasts; whenever the latter became swollen and tender from excess of milk, they were also tender and firmer. When the patient was admitted with abscess of the breast, the extra mamma; were also innear
flamed.
(B.)
Prosauno, H. F.,
two extra
mamma;
in the
aged 34, presented position as those
same
described above. She says the lumps first appeared in the fourth month of her second pregnaucy. Each of them was at first the size of a nut; with the advancement of pregnancy as the normal breasts developed, they also grew larger till they attained their present size (as big as a duck's egg). Remarks. Supplementary mamma; exist oftener than we think, and in most extraordinary situations; their sympathy with the normal breasts is sufficient to indicate their real nature.
Chittagong, \ July 1887. j
21 st
241
heart sounds were audible, but weak. I incised and forcibly dilated the os, and then applied the forceps under chloroform. Intermittent traction was employed. After an hour there was some slight advance of the head, and the foetal heart was still heard. The chloroform was then stopped, and traction continued intermittently foranotherhour. Examined again, and found foetal heart still audible. As there was some advance of the head and the child still lived, and as I did not consider that I was justified in perforating, and expected the head every moment to be sufficiently moulded to pass the brim,I again continued traction for another hour. At the end of the third hour the head had been sufficiently moulded to pass the brim, but the foetal heart sounds became weak and fluttering. Very gentle traction was now employed, and the child was delivered by forceps after 3 hours and 20 minutes. The child died about 15 minutes There was some before completion of delivery. rupture of the perineum, which was extremely
% JUiipi of losspiM |P4tiq. EDEN
CALCUTTA.
HOSPITAL,
Cases reported by Surgeon R. J.
Offg.
Civil
Polden, Surgeon, Chittagong.
The following cases which occurred whilst I Resident at the Eden Hospital, Calcutta, present points of interest: ?was
?
(1) Case of persistent Hymen impeding the passage oj the head during labour. Mrs. J., European, admitted, 15th May 1886, in labour, primipara. Age 28. 1st stage, 19 hours; 2nd stage, 2 hours, 15 minutes. When the second stage had lasted for nearly two hours, the matron, who was conducting the case, sent for me, as it seemed to her that the vagina was so narrow as to impede delivery. I examined and found the pains good ; with each pain the scalp of the child protruded through a small opening 2in. long and fin. wide when distended ; this openiug was the central aperture in a very strong hymen, which completely encircled the orifice of the vagina. During an interval between the pains I lacerated this structure by introducing a finger at either side. After this, labour proceeded so quickly, that the perineum had not time for proper distension, and a slight rupture resulted. The rupture was sutured, and case
progressed favourably.
rigid.
The
woman
made
a
good
recovery,
110
fistulte
resulting.
Remarks.?If I
were called to see such a case I should be inclined to perforate think I again, much sooner; for the long application of the forceps endangers the mother, whilst the continued pressure and traction leave the child How much the foetus very little chance of life. can endure, however, is well illustrated by this case, for the child lived till the moulding of the head was all but completed; enduring these three hours' traction and pressure, after days of pressure by the contracting uterus.
(3) Dysenteric symptoms after delivery due round toorms?18 worms passed?Subsidence sympto?ns? Cancrvm oris.
ty
to
of
Luchman, Hindu female aged 28, 4th preguancy, admitted on 27th April 1886, and delivered of a living male child the same day. She was greatly emaciated and suffered from severe
dysentery,
which
yielded
to
none
of the usual
methods of treatment.
Three weeks after delivery she passed in two days 18 round worms after which the dysenteric symptoms subsided. To add to the poor creature's miseries and to hasten the end cancrum oris set in, and I was compelled to transfer the case. Remarks.?Thia case taught me a lesson which my subsequent large experience at the Eden Hospital fully confirmed, viz., that in Lower
ANTIPYRIN RASH.
Aug., 1887.]
Bengal when you have any disturbance of the digestive tract or the reflex phenomena arising therefrom, and when the usual treatment for dysentery, diarrhoea, convulsions, &c., fails, play
your trump card, santonin. Latterly, I very often began with the santonin, and in a good proportion of cases the result justified my action. It is true that almost every subject on the postmortem table shows one or more round worms in its intestines and possibly without any symptoms indicating their existence during life; but these worms become troublesome customers when they migrate and get into unusual places and so set up irritation. In this way we lost at the Hospital a fine healthy little boy from convulsions, caused by a round worm which was working up into the stomach and stuck at the pylorus: no doubt a dose of santonin would have saved his life.
(4) Two cases of supplementary mammce. (A.) Kokil, H. F., aged 25, admitted for the treatment of mammary abscess : 011 proceeding to dress the abscess, it was found that there two supplementary mammae, one at each
were
side the anterior folds of the axilla)?they were about the size of a hen's egg and the skin over them was dark, but there was 110 separate nipple. By inquiry it was found that the lumps were not congenital; but appeared in the third month of her first pregnancy and developed with the normal breasts; whenever the latter became swollen and tender from excess of milk, they were also tender and firmer. When the patient was admitted with abscess of the breast, the extra mamma; were also innear
flamed.
(B.)
Prosauno, H. F.,
two extra
mamma;
in the
aged 34, presented position as those
same
described above. She says the lumps first appeared in the fourth month of her second pregnaucy. Each of them was at first the size of a nut; with the advancement of pregnancy as the normal breasts developed, they also grew larger till they attained their present size (as big as a duck's egg). Remarks. Supplementary mamma; exist oftener than we think, and in most extraordinary situations; their sympathy with the normal breasts is sufficient to indicate their real nature.
Chittagong, \ July 1887. j
21 st
241
