- Email: [email protected]
TEDDINGTON COTTAGE HOSPITAL.
993 of time which the cavity in the lung took to close ; it would appear that the wall of the adventitious cyst had become so rigid that it was able to resist for some time the expansile force of the surrounding lung tissue.
length
TEDDINGTON COTTAGE HOSPITAL. A CASE OF CÆSAREAN
(Under the
care
SECTION ;
of Mr. T. B.
RECOVERY.
LUSCOMBE.)
This opinion was probably strengthened by the good recovery in this hospital of the patient whose case was reported in THE LANCET of April 16th. After the usual cleansing of the skin, &c., Mr. Luscombe opened the abdomen along the linea alba. There was scarcely any hoemorrhage. The uterus was then opened by a corresponding incision, but the tissue was so soft and friable that it was not easy to avoid tearing it. As soon as possible the skull was grasped on either side over the parietal eminences with the fingers of each hand. It required some force to dislodge it and it slipped through the hands of the operator out of the abdominal incision. In the sudden escape of the head a rent occurred in the lower part of the uterus, about 2 in. long, to the left of, and at a right angle with, The placenta (which was not the previous incision. and a mass blood-clot of adherent) lying above it were then
reported below is remarkable in that the unusual was expedient adopted of removing the head from the uterus abdominal after the rest of the foetus had been section by delivered by the vagina and decapitation had been performed. It can be but rarely that such a method is justifi- removed. There was moderate haemorrhage for about a able, for as a rule if the pelvis and shoulders of the child minute or two and the blood was allowed to escape through have succeeded in passing through the mother’s pelvis it is the vagina. The cavity of the uterus was irrigated with hot water until the had practically ceased and dusted easy for the head to follow, unless by undue traction the with iodoform bleeding The incision and the rent made by powder. aftercoming head has become extended. The result of the the sudden escape of the head were sewn up with silkworm operation seems to have been very satisfactory. gut sutures I in. or less apart; a few blood-clots and some On March 26th Mr. Luscombe was asked by Dr. Theodore blood-stained fluid were sponged out of the peritoneal cavity Giinther to see a case of protracted and difficult labour. and the abdominal incision was closed with deep silkwormThe patient was thirty-one years of age and had had gut and superficial horsehair sutures. In the lower part of the three previous confinements. The first labour was said wound a piece of alembroth gauze was left for drainage and to have been a very bad one and the child had to the dressing was completed with iodoform, alembroth be taken away in pieces." The two subsequent labours wool, and a broad flannel bandage. The patient was The fcetus was a male and appear to have been uneventful, but she said that the then removed to bed. children were small. The patient was ansemic and had on examining the head it was found to be larger than a troublesome cough. Labour commenced on the evening normal and well ossified ; the fontanelles were obliterated, of March 24th; there was a breech presentation, the as the edge of one parietal bone overlapped the other child lying in the left dorso-anterior position. On the to the extent of nearly 2 in., this being probably next day the membranes ruptured and the os uteri was the result of pressure exerted by the forceps. The patient fully dilated, but very little progress had been made. Mr. passed a quiet night, had no pain, but slept very little. She Hermann Gunther also saw the patient. The foetal heart drank several teaspoonfuls of water and brandy (2 oz.) mixed sounds were distinctly heard. The pelvis was measured and with water. On the 27th the catheter was passed, the urine On the withdrawn being dark and thick. The temperature was was found to be 3 inches in the conjugate diameter. morning of the 26th the foetus was a little lower, the pains 98° F. and the pulse was 100 and feeble. During the day were not strong, and some meconium was found in the vagina. she took chicken jelly (2 oz.) and brandy (1 oz.) mixed with As the patient was getting tired it was decided to bring down water. In the evening she was restless and complained of the legs with the view of accelerating matters and chloro- abdominal pain. The gauze was removed from the lower form was given. The left leg was brought down and then part of the wound without disturbing the dressings. There with more difficulty the right leg. The body was now was a very slight serous discharge. The catheter was delivered, the shoulders giving much more trouble than the passed and the urine was found to be much clearer. The legs. To deliver the after-coming head traction on the body temperature was 98’20 and the pulse was 96 and weak. The was of no avail. Jaw traction was tried with a like result. subsequent progress of the case has no special interest. The Then forceps were applied, but with a negative result. As cough, without sufficient chest trouble to account for it, was the head did not seem to be abnormally large when grasped the chief difficulty for the first few days, whilst later with the forceps it was thought that if decapitation were obstinate constipation supervened. The temperature and the performed the manipulations with the forceps would be pulse-rate were highest on the sixth day after the operation, easier as more room and possibly a more advantageous grip being 101° and 104 per minute respectively. The patient would be obtained. This was done, but repeated efforts did not seem to be ill. on that day, and the rise in the It was at this stage that temperature from 99° in the morning was failed to extract the head. presumably due Mr. Luscombe saw the patient at about 3 P.M. She was some- to constipation, as the temperature did not again rise above what exhausted, the pulse was fairly good, and feeble pains 990. The patient left the hospital recovered at the end of occurred every few minutes. The uterus was in a condition May. of more or less tonic contraction and the chin of the foetus Remarks by Mr. LUSCOMBE.-The result of this operation, had rotated on to the pubes. The neck was gripped by the so soon after the other above referred to, and the following os uteri, so it was not possible to make much examination condition of both the patients, I venture to think present internally. Above the pubes could be seen a swelling of prove that the risks to the patients from abdominal section about the size of a small orange-the outline of the dis- were less than would have been incurred had any other tended bladder; behind and slightly above this the hard method of been resorted to and the treatment had, delivery foetal head and the placenta could easily be felt, and still the danger of moreover, the advantage of higher there was a large semi-fluctuating mass filling the lacerating the uterine or vaginalavoiding mucous membrane. found to be upper part of the uterus. This was afterwards blood-clot. An attempt was now made to empty the bladder, but the chin was so firmly fixed upon the pubes that a catheter could not be passed into the bladder. PAUPER CHILDREN IN PLYMOUTH.-At the The surroundings of the patient were not suitable ifor any of the Plymouth Board of Guardians held on meeting further operative measures, so it was decided to remove her Oct. 4th it was decided to adopt the ’’ scattered home to the Teddington Cottage Hospital with the object of The for the pauper children in the borough. system" placing her under an anaesthetic and if necessary to per- details of the scheme have yet to be settled, but doubtless forate and crush the head or perform Cassarean section. Atit will be on lines similar to those adopted by the Sheffield about 6 P.M. the A.C.E. mixture was administered. Air.board. Luscombe was then able by external manipulation to push the head just far enough upwards to allow of a catheter being FATAL CARRIAGE AcciDENT.—Much regret is passed and about a pint of blood-stained urine was obtained.Ifelt throughout North Devon at the death of Mrs. Joseph After further consultation with his colleagues who had not Harper, ] which occurred on Oct. 7th. Mrs. Harper was the iwife of Mr. seen the case before admission it was decided that to alter the Joseph Harper, L.R.C.P. Lond., M.R.C.S. Eng., of Barnstaple, and she sustained an injury to the i position of the head, without using unjustifiable force, would J.P., be practically impossible, and that the risk of abdominalbrain as the result of a carriage accident mentioned in 1 section would be less than perforation and cephalotripsy. ’.THE LANCET of Oct. 1st, p. 891. THE
case
length
TEDDINGTON COTTAGE HOSPITAL. A CASE OF CÆSAREAN
(Under the
care
SECTION ;
of Mr. T. B.
RECOVERY.
LUSCOMBE.)
This opinion was probably strengthened by the good recovery in this hospital of the patient whose case was reported in THE LANCET of April 16th. After the usual cleansing of the skin, &c., Mr. Luscombe opened the abdomen along the linea alba. There was scarcely any hoemorrhage. The uterus was then opened by a corresponding incision, but the tissue was so soft and friable that it was not easy to avoid tearing it. As soon as possible the skull was grasped on either side over the parietal eminences with the fingers of each hand. It required some force to dislodge it and it slipped through the hands of the operator out of the abdominal incision. In the sudden escape of the head a rent occurred in the lower part of the uterus, about 2 in. long, to the left of, and at a right angle with, The placenta (which was not the previous incision. and a mass blood-clot of adherent) lying above it were then
reported below is remarkable in that the unusual was expedient adopted of removing the head from the uterus abdominal after the rest of the foetus had been section by delivered by the vagina and decapitation had been performed. It can be but rarely that such a method is justifi- removed. There was moderate haemorrhage for about a able, for as a rule if the pelvis and shoulders of the child minute or two and the blood was allowed to escape through have succeeded in passing through the mother’s pelvis it is the vagina. The cavity of the uterus was irrigated with hot water until the had practically ceased and dusted easy for the head to follow, unless by undue traction the with iodoform bleeding The incision and the rent made by powder. aftercoming head has become extended. The result of the the sudden escape of the head were sewn up with silkworm operation seems to have been very satisfactory. gut sutures I in. or less apart; a few blood-clots and some On March 26th Mr. Luscombe was asked by Dr. Theodore blood-stained fluid were sponged out of the peritoneal cavity Giinther to see a case of protracted and difficult labour. and the abdominal incision was closed with deep silkwormThe patient was thirty-one years of age and had had gut and superficial horsehair sutures. In the lower part of the three previous confinements. The first labour was said wound a piece of alembroth gauze was left for drainage and to have been a very bad one and the child had to the dressing was completed with iodoform, alembroth be taken away in pieces." The two subsequent labours wool, and a broad flannel bandage. The patient was The fcetus was a male and appear to have been uneventful, but she said that the then removed to bed. children were small. The patient was ansemic and had on examining the head it was found to be larger than a troublesome cough. Labour commenced on the evening normal and well ossified ; the fontanelles were obliterated, of March 24th; there was a breech presentation, the as the edge of one parietal bone overlapped the other child lying in the left dorso-anterior position. On the to the extent of nearly 2 in., this being probably next day the membranes ruptured and the os uteri was the result of pressure exerted by the forceps. The patient fully dilated, but very little progress had been made. Mr. passed a quiet night, had no pain, but slept very little. She Hermann Gunther also saw the patient. The foetal heart drank several teaspoonfuls of water and brandy (2 oz.) mixed sounds were distinctly heard. The pelvis was measured and with water. On the 27th the catheter was passed, the urine On the withdrawn being dark and thick. The temperature was was found to be 3 inches in the conjugate diameter. morning of the 26th the foetus was a little lower, the pains 98° F. and the pulse was 100 and feeble. During the day were not strong, and some meconium was found in the vagina. she took chicken jelly (2 oz.) and brandy (1 oz.) mixed with As the patient was getting tired it was decided to bring down water. In the evening she was restless and complained of the legs with the view of accelerating matters and chloro- abdominal pain. The gauze was removed from the lower form was given. The left leg was brought down and then part of the wound without disturbing the dressings. There with more difficulty the right leg. The body was now was a very slight serous discharge. The catheter was delivered, the shoulders giving much more trouble than the passed and the urine was found to be much clearer. The legs. To deliver the after-coming head traction on the body temperature was 98’20 and the pulse was 96 and weak. The was of no avail. Jaw traction was tried with a like result. subsequent progress of the case has no special interest. The Then forceps were applied, but with a negative result. As cough, without sufficient chest trouble to account for it, was the head did not seem to be abnormally large when grasped the chief difficulty for the first few days, whilst later with the forceps it was thought that if decapitation were obstinate constipation supervened. The temperature and the performed the manipulations with the forceps would be pulse-rate were highest on the sixth day after the operation, easier as more room and possibly a more advantageous grip being 101° and 104 per minute respectively. The patient would be obtained. This was done, but repeated efforts did not seem to be ill. on that day, and the rise in the It was at this stage that temperature from 99° in the morning was failed to extract the head. presumably due Mr. Luscombe saw the patient at about 3 P.M. She was some- to constipation, as the temperature did not again rise above what exhausted, the pulse was fairly good, and feeble pains 990. The patient left the hospital recovered at the end of occurred every few minutes. The uterus was in a condition May. of more or less tonic contraction and the chin of the foetus Remarks by Mr. LUSCOMBE.-The result of this operation, had rotated on to the pubes. The neck was gripped by the so soon after the other above referred to, and the following os uteri, so it was not possible to make much examination condition of both the patients, I venture to think present internally. Above the pubes could be seen a swelling of prove that the risks to the patients from abdominal section about the size of a small orange-the outline of the dis- were less than would have been incurred had any other tended bladder; behind and slightly above this the hard method of been resorted to and the treatment had, delivery foetal head and the placenta could easily be felt, and still the danger of moreover, the advantage of higher there was a large semi-fluctuating mass filling the lacerating the uterine or vaginalavoiding mucous membrane. found to be upper part of the uterus. This was afterwards blood-clot. An attempt was now made to empty the bladder, but the chin was so firmly fixed upon the pubes that a catheter could not be passed into the bladder. PAUPER CHILDREN IN PLYMOUTH.-At the The surroundings of the patient were not suitable ifor any of the Plymouth Board of Guardians held on meeting further operative measures, so it was decided to remove her Oct. 4th it was decided to adopt the ’’ scattered home to the Teddington Cottage Hospital with the object of The for the pauper children in the borough. system" placing her under an anaesthetic and if necessary to per- details of the scheme have yet to be settled, but doubtless forate and crush the head or perform Cassarean section. Atit will be on lines similar to those adopted by the Sheffield about 6 P.M. the A.C.E. mixture was administered. Air.board. Luscombe was then able by external manipulation to push the head just far enough upwards to allow of a catheter being FATAL CARRIAGE AcciDENT.—Much regret is passed and about a pint of blood-stained urine was obtained.Ifelt throughout North Devon at the death of Mrs. Joseph After further consultation with his colleagues who had not Harper, ] which occurred on Oct. 7th. Mrs. Harper was the iwife of Mr. seen the case before admission it was decided that to alter the Joseph Harper, L.R.C.P. Lond., M.R.C.S. Eng., of Barnstaple, and she sustained an injury to the i position of the head, without using unjustifiable force, would J.P., be practically impossible, and that the risk of abdominalbrain as the result of a carriage accident mentioned in 1 section would be less than perforation and cephalotripsy. ’.THE LANCET of Oct. 1st, p. 891. THE
case