OBSTETRICS.
Scirrhus of the Uterus complicated with Pregnancy ; Funis presenta-
tion ; Delivery.—Mr. I. Brown read the following case: Mrs. W---,
aged thirty-five, an oat-patient of St. Mary’s Hospital, was under my
care from May to July with scirrhus of the os and cervix uteri. The
catameni i had ceased for several weeks, but there was a good deal of
offensive serous discharge. Her health became so seriously injured,
that she was unable to continue her attendance as an out patient, and I
lost sight of her until November 18th, when I was requested by Mr.
Hammond, one of the district accoucheurs of the Maternity, to visit
her. I found that she had been seized with symptoms of labor the
previous day, that the waters had escape 1, and that the funis had
descended six or eight inches through the os externum; but the
thickened edges of the uterus seemed quite unyielding, and the labor
made little or no progress. The patient became excessively exhausted,
requiring ammonia, brandy, and strong beef-tea. I suggested that they
should wait and see if the os dilated a little more, and if it did that
delivery should be attempted by turning. Turning was accomplished
the following day by Mr. Bullock, resident-surgeon to St. Mary’s Hos-
pital, and Mr. Hammond, after considerable difficulty. The foetus was
one of seven months, and had been dead some five or six days. The
patient remained in a very exhausted state after her delivery, and when
Mr. B rown last saw her, was evidently fast sinking.
In answer to questions, Mr. Brown could not say how long the
disease had existed, but he supposed for some time. About half the
os was involved in the ulceration.
Dr. Routh recollected the case of a woman in Vienna, in whom
three fourths of the os were involved in the ulceration. The woman
was four days in labor, and died four or five days after delivery. The
delivery was effected, not through the os, but on one side of it. The
woman died of peritonitis.
Dr. Barnes said that the practical question in this case was, as to
the propriety of effecting premature delivery to avoid the passage of a
large body through the diseased os. Would such a proceeding give the
patient a chance of recovery? Me thought that the cases of Dr. How-
land had proved the contrary, and that as death would result whenever
delivery took place, life of course would be prolonged by allowing the
woman to go the full time.