OBSTETRICS.
Cases of Pregnancy, notwithstanding previous severe injury to the
organs concerned in Childbirth. By Dr. Leopold, of Meeran, Schon-
burgh.—Case 1.—Mrs.------was delivered with instruments, on the
1st of January, 1843, by an experienced accoucheur, and suffered con-
siderably from ischuria on the following day. On the 6th, Dr. Leo-
pold saw her in consultation. A large hard tumor, tender to the touch,
filled the greater part of the vagina. The nature of this tumor was
doubtful, and continued so until the 9th inst., when, having taken a
strong purgative, she felt during its action a substance pass from the
vagina. Copious haemorrhage occurred, followed by syncope. On
examination the prolapsed and inverted uterus was found between her
thighs, lying in a pool of blood, urine and faeces. It was immediately
washed and returned. The haemorrhage ceased; the fundus uteri could
be felt beneath the abdominal parietes. The patient was confined to
the recumbent posture for many weeks. She perfectly recovered her
health, and was delivered of another child two years afterwards with-
out instrumental aid. In this case it is possible that partial inversion
of the uterus may have been occasioned at the time of delivery by ad-
hesion of the placenta, and that the subsequent accident converted this
into complete inversion and prolapsus.
Case 2.—Mrs.------, the mother of five children, was in labor on
March 30th, 1844. The arm presented, and it was necessary to turn.
During the operation the patient exclaimed that she was suffering ex-
cruciating pain in the left side of the pelvis. She threw herself about
in the most inconvenient positions just as Dr. Leopold had reached the
foot. Much care was required to complete the delivery, as the pains
also flagged. The placenta was expelled without haemorrhage. At
midnight of the same day Dr. Leopold was summoned to her, and
found her lying with all the symptoms of severe haemorrhage, but only
a few ounces of blood were found in the bed. On passing the hand
into the vagina several large coagula were expelled. The uterus was
found lying over to the right side of the pelvis. The os uteri was open,
and the uterus contained some coagula, which were quickly expelled
by the contractions of the organ from external and internal stimulation.
On the left side of the vagina, the hand entered a large sac full of
blood. The orifice of this sac was about an inch from the os uteri, and
was sufficiently large to admit the hand without force. Its walls were
formed by the iliac bone, by the abdominal parietes, as high as the
crista ilii, and by the iliac.us internus muscle. A large quantity of
coagulated blood was removed, and further haemorrhage restrained by
continued external application of cold. The patient refused all inter-
nal remedies. The prognosis was unfavorable. The extent of the
injury indicated a remote origin; and, on inquiry, it was learnt that
the patient had suffered from pain in the left side and hip during the
whole period of her pregnancy, but had been compelled to follow her
work at the loom.
The pains during labor were frequent and violent. A short time
before the rupture of the membranes she had experienced a sensation
as of a sudden and painful giving way of the parts on the left side.
She had suffered from peritonitis after her previous confinement. A
chronic abscess had no doubt existed in this spot, and was ruptured
during labor by the force of the pains and the cross position of the
child. The patient had again on this occasion an attack of puerperal
fever, from which she recovered in three weeks. A purulent dis-
charge continued for upwards of three months, after which she per-
fectly regained her health and strength, with the exception of di-
minished power in the left hip joint. Two years afterwards she was
again confined, without any unfavorable occurrence.—Lond. Med. Gaz.