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MAGGOTS IN THE UTERUS.
16 prove of interest to my confrdl’cs. Playfair, speaking of theof fcetal mortality in pelvic states that Joulin thinks that may be also produced by the was dissected in its middle two-fourths. The area inclucled compression of the placenta between the contracted uterus within the limits above described comprised the anterior and the foetal skull. In my case, I have no doubt that of the funis between the triangle, submaxillary, and superficial part of the pterygo- death was due to maxillary region. The destructive process had gone on so uterus and placenta on the one hand, and the right hip of completely that it would necessarily entail an enumeration of the child on the other, for T distinctly felt the funis in the contents of these regions were one to enter into a descrip- that situation in my first examination. I may remark that tion of the denuded parts. The vessels, however, maybe men- the child was born at full term. tioned as stretching from one part to another, and resembling Trinidad, W.I. strings; these were the anterior and external jugular veins and branches of the external carotid artery, in to a MAGGOTS IN THE UTERUS. of the internal jugular vein. This ulcerated process, at part BY J. F. HAINES, M.D. first rapid, accompanied with great pain, copious offensive the and of the discharges, frequent haemorrhages, presence dark-coloured slireddy sloughs like those described by THE following case, which has occurred in my practice, Mr. Williams, became quiescent after eroding the cutaneous may be of interest :structures and adipose and loose areolar tissues. The patient I was called to see Mrs. P——,who Some months died from exhaustion, though from the frequent bleeding stated that she ago had had "a miscarriage"three days preand the condition of the vessels it was expected that he now and was suffering from considerable pain. would die from haemorrhage. I may mention that the first viously, was an intensely fetid discharge, and, on making an There noticeable symptom was a swelling over the parotid region, I was surprised to discover a number of which extended gradually downwards into the neck, when examination, maggots in the vagina. I injected a solution of carbolic to the upper border of the manubrium sterni below, anteriorly extending to the median line, and posteriorly to just beyond the posterior margin of the sterno-mastoid, which muscle
presentations,
causes
asphyxia
compression
_______________
addition
it
was incised. had but little effect, only a few Mr. Williams’s case and the above I should put down as acid, which, however, with the return of the fluid. I then coming maggots away being examples of sloughing phagedpena, though his case is used as an injection a solution of perchloride of mercury, complicated with what must be regarded as epithelioma of which killed and brought away a very large quantity of the lip. That the subsequent affection is not secondary them. The patient now expressed herself as considerably been cancer isinvasion my belief;andhad it beenofso,thethere shouldandhave there being no urgent symptoms, I prescribed and, relieved, not the tissues, greater matting a mixture containing tincture of opium and liquid extract clean dissection described by him. of ergot. Next day I repeated the injection of the perWest Kensington. chloride, and on the following day a mass about the size of a small orange was expelled, which was riddled with holes, A RARE CASE OF MIDWIFERY. and contained a number of dead maggots. I was unable to, BY PEDRO L. DE MONTBRUN, M.R.C.S.E., L.R.C.P.LOND., satisfy myself as to whether it contained any fcetal structure or not. After this the patient steadily improved, and GOVERNMENT MEDICAL OFFICER; ACTING MEDICAL SUPERINTENDENT OF THE LEPER ASYLUM, TRINIDAD, WEST INDIES. made a good recovery. I shall be glad to have suggestions from any of theON the evening of Oct. 6th, 1888, I was summoned to numerous readers of THE LANCET as to the cause and origin of the maggots in this unusual situation. attend a multipara who had been in labour for over six St. John’s-road, N. hours. The membranes had ruptured an hour before my arrival. On examination, I discovered the toes of the right foot presenting at the vaginal outlet, and looking upwards towards the mother’s abdomen, and also a loop of the 11 OF cord," which was cold and flaccid, and in which there was I felt part of the placenta on the right side no pulsation. HOSPITAL of the womb, and protruding through the os. The left knee, BRITISH AND FOREIGN. just escaping through the os, was gently pulled down and Labour then progressed satisfactorily until the body of the child as far as the umbilicus was born. Seeing Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morthere was some delay, I searched, but, failing to find the borum et dissectionum historias, tum aliorum tum proprias collectas et inter se comparare.-MORGAGNi De Sed. et Cats. 3fo2-b.,, elbows, I concluded that the arms were extended above the habere, iv. Prooemium. child’s head. Applying the usual manoeuvres in such cases, MIDDLESEX HOSPITAL. I brought down the arms. Labour again continued easily until the shoulders were born, when a fresh difficulty arose- EXTREME RACHITIC DEFORMITY IN A PREGNANT FEMALE; viz., delay of the birth of the head. Examining, I found PORRO’S OPERATION; RECOVERY OF MOTHER the chin extended and hitching against the pubes. Failing AND CHILD; REMARKS. in my endeavours to perform rotation forward of the care of Dr. WILLIAM DUNCAN.) the (Under occiput and flexion of the chin, I drew the body forwards towards mother’s and upwards the abdomen. NotwithIT was in the year 1876 that Professor Porro performed standing this manoeuvre, which was repeated several times, for the first time the operation which goes by his name. and there being still delay, I introduced my left hand along As a result of the success obtained in that case and a the concavity of the sacrum, and, grasping the occiput, I assisted its delivery by traction in a downward and forward memoir afterwards published by him on the subject, the direction. The occiput swept over the perineum and was operation has frequently been performed since, both on the born first, and the face quickly followed. The placenta Continent and in Great Britain. He was not the first to, The uterus con- suggest the removal of the uterus. Blundell (THE LANCET, was expelled immediately afterwards. tracted firmly, and all went well with the patient. vol. ii. 1828, 167) thought the dangers of the Cacsarean secRc-ma.rl"s.-I classify this case as one prmvia tion might bep. diminished by the removal of the uterus after with pelvic presentation. There was also prolapse of the its and Storer did this in 1869, on account Dr. performance; funis, due, without doubt, to the low attachment of the the to lower of uterus. There was of the with the met the uterine wound.1 By from placenta segment haemorrhage not much haemorrhage either before or after delivery. far the larger majority of the patients operated on have been Dr. Playfair remarks, in his " Science and Practice of Mid- the subjects of rickety deformity of the pelvis, and it is in wifery," that such a mode of termination-viz., birth of the these more permanent conditions of disease that this operaocciput before the face, as in my case,-though mechanically tion is The method of Sanger referred to indicated. specially possible, is certainly an event of extreme rarity. Cazeaux, in his "Traite des Accouchements," says : "Leroux, by Dr. Duncan in his remarks, by means of which the dangers Michaelis, Asdrubali ont observe des faits semblables ; of the Caosarean section are diminished, consists in suturing, mais ils sont tres rares." It is because of its extreme rarity 1 See that I have reported this case, feeling confident that it will paper by Dr. Godson referred to by Dr. Duncan.
A Mirror
PRACTICE,
delivered.
lib.
-
of placenta
I
presentations,
causes
asphyxia
compression
_______________
addition
it
was incised. had but little effect, only a few Mr. Williams’s case and the above I should put down as acid, which, however, with the return of the fluid. I then coming maggots away being examples of sloughing phagedpena, though his case is used as an injection a solution of perchloride of mercury, complicated with what must be regarded as epithelioma of which killed and brought away a very large quantity of the lip. That the subsequent affection is not secondary them. The patient now expressed herself as considerably been cancer isinvasion my belief;andhad it beenofso,thethere shouldandhave there being no urgent symptoms, I prescribed and, relieved, not the tissues, greater matting a mixture containing tincture of opium and liquid extract clean dissection described by him. of ergot. Next day I repeated the injection of the perWest Kensington. chloride, and on the following day a mass about the size of a small orange was expelled, which was riddled with holes, A RARE CASE OF MIDWIFERY. and contained a number of dead maggots. I was unable to, BY PEDRO L. DE MONTBRUN, M.R.C.S.E., L.R.C.P.LOND., satisfy myself as to whether it contained any fcetal structure or not. After this the patient steadily improved, and GOVERNMENT MEDICAL OFFICER; ACTING MEDICAL SUPERINTENDENT OF THE LEPER ASYLUM, TRINIDAD, WEST INDIES. made a good recovery. I shall be glad to have suggestions from any of theON the evening of Oct. 6th, 1888, I was summoned to numerous readers of THE LANCET as to the cause and origin of the maggots in this unusual situation. attend a multipara who had been in labour for over six St. John’s-road, N. hours. The membranes had ruptured an hour before my arrival. On examination, I discovered the toes of the right foot presenting at the vaginal outlet, and looking upwards towards the mother’s abdomen, and also a loop of the 11 OF cord," which was cold and flaccid, and in which there was I felt part of the placenta on the right side no pulsation. HOSPITAL of the womb, and protruding through the os. The left knee, BRITISH AND FOREIGN. just escaping through the os, was gently pulled down and Labour then progressed satisfactorily until the body of the child as far as the umbilicus was born. Seeing Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morthere was some delay, I searched, but, failing to find the borum et dissectionum historias, tum aliorum tum proprias collectas et inter se comparare.-MORGAGNi De Sed. et Cats. 3fo2-b.,, elbows, I concluded that the arms were extended above the habere, iv. Prooemium. child’s head. Applying the usual manoeuvres in such cases, MIDDLESEX HOSPITAL. I brought down the arms. Labour again continued easily until the shoulders were born, when a fresh difficulty arose- EXTREME RACHITIC DEFORMITY IN A PREGNANT FEMALE; viz., delay of the birth of the head. Examining, I found PORRO’S OPERATION; RECOVERY OF MOTHER the chin extended and hitching against the pubes. Failing AND CHILD; REMARKS. in my endeavours to perform rotation forward of the care of Dr. WILLIAM DUNCAN.) the (Under occiput and flexion of the chin, I drew the body forwards towards mother’s and upwards the abdomen. NotwithIT was in the year 1876 that Professor Porro performed standing this manoeuvre, which was repeated several times, for the first time the operation which goes by his name. and there being still delay, I introduced my left hand along As a result of the success obtained in that case and a the concavity of the sacrum, and, grasping the occiput, I assisted its delivery by traction in a downward and forward memoir afterwards published by him on the subject, the direction. The occiput swept over the perineum and was operation has frequently been performed since, both on the born first, and the face quickly followed. The placenta Continent and in Great Britain. He was not the first to, The uterus con- suggest the removal of the uterus. Blundell (THE LANCET, was expelled immediately afterwards. tracted firmly, and all went well with the patient. vol. ii. 1828, 167) thought the dangers of the Cacsarean secRc-ma.rl"s.-I classify this case as one prmvia tion might bep. diminished by the removal of the uterus after with pelvic presentation. There was also prolapse of the its and Storer did this in 1869, on account Dr. performance; funis, due, without doubt, to the low attachment of the the to lower of uterus. There was of the with the met the uterine wound.1 By from placenta segment haemorrhage not much haemorrhage either before or after delivery. far the larger majority of the patients operated on have been Dr. Playfair remarks, in his " Science and Practice of Mid- the subjects of rickety deformity of the pelvis, and it is in wifery," that such a mode of termination-viz., birth of the these more permanent conditions of disease that this operaocciput before the face, as in my case,-though mechanically tion is The method of Sanger referred to indicated. specially possible, is certainly an event of extreme rarity. Cazeaux, in his "Traite des Accouchements," says : "Leroux, by Dr. Duncan in his remarks, by means of which the dangers Michaelis, Asdrubali ont observe des faits semblables ; of the Caosarean section are diminished, consists in suturing, mais ils sont tres rares." It is because of its extreme rarity 1 See that I have reported this case, feeling confident that it will paper by Dr. Godson referred to by Dr. Duncan.
A Mirror
PRACTICE,
delivered.
lib.
-
of placenta
I