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BRIEF NOTES OF A CASE OF PRETERNATURAL AND DIFFICULT LABOUR, FOLLOWED BY THE CÆSAREAN SECTION.
475 diathesis; but if it should, I know not how better to meet it than again to destroy it by limitary cauterization, for I have not met with a description of an affection of this kind in any treatise. Wimpole-street. Oct. 1862.
BRIEF NOTES OF A CASE OF
PRETERNATURAL AND DIFFICULT
LABOUR,
FOLLOWED BY THE
CÆSAREAN BY
DAVID
SECTION.
JOHNSON, M.D.
ON
Thursday evening, Aug.7th, 1862, at hajfpast six, I for to E. M-, in labour of her first child, having history was in every respect obscure ; and as he presented him- gone the full period of gestation. She was seventeen years of self with only a leucoma, and none of the bladder-like appearage, very short ir, stature, and unmarried; and had been very ances which he described, I could only surmise that this was a when a child. She was under the care of a midwife, very interesting case of fistula of the anterior chamber. There On my arrival, I ascertained was a very fine valvular aperture in the cornea, from which a who requested my assistance. sinus ran through its structure beneath the thickened epithelial that she had been in labour about twelve hours, but that her covering of the cornea and under the sclerotical conjunctiva pains had ceased some time. She was greatly depressed and to a limited extent. Mr. White Cooper and Mr. Soelbergr restlem, her pulse quick, and tongue much furred. On exaWells concurred in my opinion. Caustics had been applied on; mination, the right hand lay in the vagina, with about eight innumerable occasions, and various other applications made. inches of the cord prolapsed ; while a little higher up both feet I contented myself with desiring the patient to wait untill could be felt, evidently right and left. High up beyond the "the bladder filled," and to come to see me then. He called brim I could detect the head, but there was very little availone day with the sac distended. I then introduced a very fine able space, and the parts were exceedingly dry and hot. With knife, shaped like a needle, but with a cutting edge along it, some little difficulty I grasped the feet, intending to bring and laid open the whole length of the sinus. I then took a them down and deliver by turning; but after using what pair of fine-bladed scissors, and cut off the minute remaining I considered warrantable extending force several times, I loose edges. I treated it, in fact, exactly as I should a sinuss ultimately abandoned that idea; and passing my hand at this elsewhere. It healed thoroughly and rapidly. The use ojf juncture as high as I possibly could revealed a pelvis which at caustics would not, I think, ever have effected a cure. Thee its brim did not appear tobe more than two inches and a half in diameter. My impression was, that, to turn or alter the case is one of much interest; for fistula of the cornea, is a raree affection, and one of which the rules oi treatment are not yeit position was utterly impracticable. Finding the case a bad one, 1 sent fur my friend, Mr. Thompthoroughly deiined. I will close these notes by referring to a remarkable cas( son, a surgeon of much midwifery experience, who remained of naevus of the eyeball, caruncle, and brow, which has lately with me for some hours. Every effort at delivery proved unbeen under my care, and which still puzzles me how to com availing. The top of the vertex of the child being within reach, which, afcer emptying the plete its treatment. This child has the naevoid diathesis t we determined upon craniotomy, When brought to me, a nsevus occu a remarkable degree. bladder,I performed through the anterior fontanelle; but alpied the caruncle and edge of the lids, spreading nearly to th though the whole of the brain was evacuated, with several edge of the cornea. It was of a raspberry colour, highly vas portions of the cranium, yet with all the exertion we dare use cular, and the seat of frequent haemorrhages. A large lum] by the aid of the crotchet and Dr. Davies’ forceps, the head was
sent
rickety
.
,
still maintained its
position, not moving in the slightest degree. Finding it, therefore, impossible to accomplish the delivery, and feeling assured that it ought not to be delayed any longer, I proposed, lastly, the Caesarean section, to which Mr. Thompson, Mr. Pope, and Mr. Finch, after a fair trial to deliver, agreed. this we were disappointed for several hours, not being able to gain the consent of the patient, while her friends lived ten miles away. By this time, which was sixteen hours after I first saw her, she had become restltss, hot, and feverish, with a pulse risen to 130. She, however, at length consented, and I performed the operation at one o’clock on Friday, in the usual manner, in a temperature of 76°. There was little haemorrhage, and she bOlethe operation with great fortitude, and at its comexpressed herself greatly relieved. ! pietion I saw her at two o’clock, being an hour after the operation. Her pulse was 134 and weak, and there was a little oozing through the vagina, and she complained of pain. I g--,ve her two grams of solid opium, which relieved her. The abdomen
In
at
four o’clock
considerably
swollen, but not tender upon twice since I last saw her, but at intervals of ten minutes in minute quantities. At six she seemed better, and retained everything; had voided urine several times, and the discharge appeared natural. At eight the abdomen was very tympanitio, she complained of great pain across the chest; respiration was hurried, tongue very dry, and pulse mounted to 141 ; no had slept well nevertheless, and expressed herself was
She had vomited pressure. had taken food aud drink may be
the forehead and brow, which is also evidently naevoid growth ; and nasvi of the tongue. exist, running along its edges, and occupying the middle line of the dorsum, its edges, and the fraenum. The latter. I may remark en passant, is a rare position ; that on the eyeball is very unusual indeed. I proceeded, however, very carefully to destroy it with better. From this time she went on satisfactorily until Sunday hardened sticks of caustic prepared by Savory and Moore, carpwhen she was attacked with rigors and vomiting, herfully guarding the cornea, and doing a. little at a time. With patience the eye was now cleared. and the caruncle also. But I pulse rising to 144, respirations 40, breathing laboured, tongue and had wandered a good deal the was puzzled to know what to do for that in the brow. I am emcoated, face few hours. I saw her at eleven o’clock, and she expressed ploying pressure, which Mr. Christopher Heath, who saw the! child lately with me, thought might benefit it; and for this herself be-ter. Soon after I left her she desired to be raised a purpose I have had a kind of spring truss constructed by Mr. little, and sank instantly, having survived the operation fortyBigg. But I fear little good BB ill result from that plan. six hours. I could not obtain the sanction of the friends for a I am not sure that the naevus may not recur at the caruncle andI examination. spread on to the eyeball, for this child has a distinctly naevoidL ! Tetteuhall, Oct. 1862. a
seen over
subcutaneous
and
sickness ,
morning, highly last
Heather
post-mortem
flushed,
BRIEF NOTES OF A CASE OF
PRETERNATURAL AND DIFFICULT
LABOUR,
FOLLOWED BY THE
CÆSAREAN BY
DAVID
SECTION.
JOHNSON, M.D.
ON
Thursday evening, Aug.7th, 1862, at hajfpast six, I for to E. M-, in labour of her first child, having history was in every respect obscure ; and as he presented him- gone the full period of gestation. She was seventeen years of self with only a leucoma, and none of the bladder-like appearage, very short ir, stature, and unmarried; and had been very ances which he described, I could only surmise that this was a when a child. She was under the care of a midwife, very interesting case of fistula of the anterior chamber. There On my arrival, I ascertained was a very fine valvular aperture in the cornea, from which a who requested my assistance. sinus ran through its structure beneath the thickened epithelial that she had been in labour about twelve hours, but that her covering of the cornea and under the sclerotical conjunctiva pains had ceased some time. She was greatly depressed and to a limited extent. Mr. White Cooper and Mr. Soelbergr restlem, her pulse quick, and tongue much furred. On exaWells concurred in my opinion. Caustics had been applied on; mination, the right hand lay in the vagina, with about eight innumerable occasions, and various other applications made. inches of the cord prolapsed ; while a little higher up both feet I contented myself with desiring the patient to wait untill could be felt, evidently right and left. High up beyond the "the bladder filled," and to come to see me then. He called brim I could detect the head, but there was very little availone day with the sac distended. I then introduced a very fine able space, and the parts were exceedingly dry and hot. With knife, shaped like a needle, but with a cutting edge along it, some little difficulty I grasped the feet, intending to bring and laid open the whole length of the sinus. I then took a them down and deliver by turning; but after using what pair of fine-bladed scissors, and cut off the minute remaining I considered warrantable extending force several times, I loose edges. I treated it, in fact, exactly as I should a sinuss ultimately abandoned that idea; and passing my hand at this elsewhere. It healed thoroughly and rapidly. The use ojf juncture as high as I possibly could revealed a pelvis which at caustics would not, I think, ever have effected a cure. Thee its brim did not appear tobe more than two inches and a half in diameter. My impression was, that, to turn or alter the case is one of much interest; for fistula of the cornea, is a raree affection, and one of which the rules oi treatment are not yeit position was utterly impracticable. Finding the case a bad one, 1 sent fur my friend, Mr. Thompthoroughly deiined. I will close these notes by referring to a remarkable cas( son, a surgeon of much midwifery experience, who remained of naevus of the eyeball, caruncle, and brow, which has lately with me for some hours. Every effort at delivery proved unbeen under my care, and which still puzzles me how to com availing. The top of the vertex of the child being within reach, which, afcer emptying the plete its treatment. This child has the naevoid diathesis t we determined upon craniotomy, When brought to me, a nsevus occu a remarkable degree. bladder,I performed through the anterior fontanelle; but alpied the caruncle and edge of the lids, spreading nearly to th though the whole of the brain was evacuated, with several edge of the cornea. It was of a raspberry colour, highly vas portions of the cranium, yet with all the exertion we dare use cular, and the seat of frequent haemorrhages. A large lum] by the aid of the crotchet and Dr. Davies’ forceps, the head was
sent
rickety
.
,
still maintained its
position, not moving in the slightest degree. Finding it, therefore, impossible to accomplish the delivery, and feeling assured that it ought not to be delayed any longer, I proposed, lastly, the Caesarean section, to which Mr. Thompson, Mr. Pope, and Mr. Finch, after a fair trial to deliver, agreed. this we were disappointed for several hours, not being able to gain the consent of the patient, while her friends lived ten miles away. By this time, which was sixteen hours after I first saw her, she had become restltss, hot, and feverish, with a pulse risen to 130. She, however, at length consented, and I performed the operation at one o’clock on Friday, in the usual manner, in a temperature of 76°. There was little haemorrhage, and she bOlethe operation with great fortitude, and at its comexpressed herself greatly relieved. ! pietion I saw her at two o’clock, being an hour after the operation. Her pulse was 134 and weak, and there was a little oozing through the vagina, and she complained of pain. I g--,ve her two grams of solid opium, which relieved her. The abdomen
In
at
four o’clock
considerably
swollen, but not tender upon twice since I last saw her, but at intervals of ten minutes in minute quantities. At six she seemed better, and retained everything; had voided urine several times, and the discharge appeared natural. At eight the abdomen was very tympanitio, she complained of great pain across the chest; respiration was hurried, tongue very dry, and pulse mounted to 141 ; no had slept well nevertheless, and expressed herself was
She had vomited pressure. had taken food aud drink may be
the forehead and brow, which is also evidently naevoid growth ; and nasvi of the tongue. exist, running along its edges, and occupying the middle line of the dorsum, its edges, and the fraenum. The latter. I may remark en passant, is a rare position ; that on the eyeball is very unusual indeed. I proceeded, however, very carefully to destroy it with better. From this time she went on satisfactorily until Sunday hardened sticks of caustic prepared by Savory and Moore, carpwhen she was attacked with rigors and vomiting, herfully guarding the cornea, and doing a. little at a time. With patience the eye was now cleared. and the caruncle also. But I pulse rising to 144, respirations 40, breathing laboured, tongue and had wandered a good deal the was puzzled to know what to do for that in the brow. I am emcoated, face few hours. I saw her at eleven o’clock, and she expressed ploying pressure, which Mr. Christopher Heath, who saw the! child lately with me, thought might benefit it; and for this herself be-ter. Soon after I left her she desired to be raised a purpose I have had a kind of spring truss constructed by Mr. little, and sank instantly, having survived the operation fortyBigg. But I fear little good BB ill result from that plan. six hours. I could not obtain the sanction of the friends for a I am not sure that the naevus may not recur at the caruncle andI examination. spread on to the eyeball, for this child has a distinctly naevoidL ! Tetteuhall, Oct. 1862. a
seen over
subcutaneous
and
sickness ,
morning, highly last
Heather
post-mortem
flushed,