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Simultaneous abortion and sterilization
724
THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Baldwin, J. F.: Hysterectomy in Certain Cases of Pulmonary Tuberculosis; Par· ticularly as an Alternative for Therapeutic Abortion. Surgery, Gynecology and Obstetrics, 1923, xxxvii, 201. Tlte author maintainH that a total hysterectomy ( prcserdng the adnexa in younger women) is a preferable procedure to inducing abortion in cases of active tuberculosis complicated by pregnancy. Indications for the procedure are extended to enver nonpregnant women with pulmonary tuberculosis who are u handicapped by monthly loss of blood, profuse leuconhea, or uterine hyperplasia with all its distressing Rymptoms of backache, hearing-down, dyspareunia, etc.'' The author used ether by the open-drop method ag an anesthetic and states that fifteen minutes usually suffices to complete the procedure from incision to closure; including support of the vaginal vault, peritonealization of the floor of the pelvis, appendectomy and examination of the gall bladder. Occasionally, he says, the oprra.tion may be prolonged when meBting extensive adhesions or when accompauied by a perineal repair, but except under extremE' cireumstanees no competent operator should require more than thirty minutes for an operation of this kind. CREADICK. Siegert, F.: Results of Supravaginal Amputation and Castration in Tuberculous Women. Medizinische Klinik, 1923, xix, 1150. Most authors nowadays are agreed that it is best to interrupt pregnancy as early as possible when complicated by pulmonary tuberculosis. Bumm, in Hlll, advocated removal of the uterus, tuheR, and ovaries in these patients, claiming that castration fa\'OJ·ably influences the deposition of fat and stimulates metabolism, thereby increasing the resistance of the body. Since Hll8 the radical operation has been performed in the Frciburg- Clinic on 26 patients. By doing this operation the puerperium, whirh is the period of greatest danger to the tuberculous gravida, was eliminated. Lumbar anesthesia was used and in nearly all the cases the ope1·ation performed between the second and fourth months of pregnancy. Only ll women showed menopausal symptoms. Of the 26 women, 20 were improved, 4 were not improved, and 2 could not he traced. Of thosP who were improved the tuberculous process was cured in 12, and 1 died after two an·d half years. The 4 patients who were not improved died from one to eleven months after operatiOJI. J. P. GREENHILL. Diitzmann, M.: Simultaneous Abortion and Sterilization. burtshilfe und Gyniiikologie, 1924, Jxv, 18fl.
Monatsschrift flir Ge-
'l'he author performed combined abortion and sterilization operations on fi9 patients without a single death or complication. His operation is performed as follows: An ordinary colpotomy is done. The uterus iii pulled forward into view. Just above the internal os the uterus is opened for a distance of 2 to 3 em. and the ovum rt'moved with ovum forceps. The uterine cavity is curetted and a pack inserted and led out through the cervix.. or the cervical canal may simply be dilated with a sound. There is little bleeding and the contracted uterus is very easily pulled out to the vulva. In full view sterilization is now performed. The tube on each side is clamped and cut, avoiding the tubal artery where possible. Both cnt ends are buried in the broad ligaments. A suture is introduced into the anterior layer of the broad ligament, then through the tubal end, and finally through the posterior layer of the ligalllent but behind the tubal openings. The incision in the uterus is closed and a typical vaginal fixation performed so that the uterine incision becomes extraperitoneal. J. P. GREENHILL.
THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Baldwin, J. F.: Hysterectomy in Certain Cases of Pulmonary Tuberculosis; Par· ticularly as an Alternative for Therapeutic Abortion. Surgery, Gynecology and Obstetrics, 1923, xxxvii, 201. Tlte author maintainH that a total hysterectomy ( prcserdng the adnexa in younger women) is a preferable procedure to inducing abortion in cases of active tuberculosis complicated by pregnancy. Indications for the procedure are extended to enver nonpregnant women with pulmonary tuberculosis who are u handicapped by monthly loss of blood, profuse leuconhea, or uterine hyperplasia with all its distressing Rymptoms of backache, hearing-down, dyspareunia, etc.'' The author used ether by the open-drop method ag an anesthetic and states that fifteen minutes usually suffices to complete the procedure from incision to closure; including support of the vaginal vault, peritonealization of the floor of the pelvis, appendectomy and examination of the gall bladder. Occasionally, he says, the oprra.tion may be prolonged when meBting extensive adhesions or when accompauied by a perineal repair, but except under extremE' cireumstanees no competent operator should require more than thirty minutes for an operation of this kind. CREADICK. Siegert, F.: Results of Supravaginal Amputation and Castration in Tuberculous Women. Medizinische Klinik, 1923, xix, 1150. Most authors nowadays are agreed that it is best to interrupt pregnancy as early as possible when complicated by pulmonary tuberculosis. Bumm, in Hlll, advocated removal of the uterus, tuheR, and ovaries in these patients, claiming that castration fa\'OJ·ably influences the deposition of fat and stimulates metabolism, thereby increasing the resistance of the body. Since Hll8 the radical operation has been performed in the Frciburg- Clinic on 26 patients. By doing this operation the puerperium, whirh is the period of greatest danger to the tuberculous gravida, was eliminated. Lumbar anesthesia was used and in nearly all the cases the ope1·ation performed between the second and fourth months of pregnancy. Only ll women showed menopausal symptoms. Of the 26 women, 20 were improved, 4 were not improved, and 2 could not he traced. Of thosP who were improved the tuberculous process was cured in 12, and 1 died after two an·d half years. The 4 patients who were not improved died from one to eleven months after operatiOJI. J. P. GREENHILL. Diitzmann, M.: Simultaneous Abortion and Sterilization. burtshilfe und Gyniiikologie, 1924, Jxv, 18fl.
Monatsschrift flir Ge-
'l'he author performed combined abortion and sterilization operations on fi9 patients without a single death or complication. His operation is performed as follows: An ordinary colpotomy is done. The uterus iii pulled forward into view. Just above the internal os the uterus is opened for a distance of 2 to 3 em. and the ovum rt'moved with ovum forceps. The uterine cavity is curetted and a pack inserted and led out through the cervix.. or the cervical canal may simply be dilated with a sound. There is little bleeding and the contracted uterus is very easily pulled out to the vulva. In full view sterilization is now performed. The tube on each side is clamped and cut, avoiding the tubal artery where possible. Both cnt ends are buried in the broad ligaments. A suture is introduced into the anterior layer of the broad ligament, then through the tubal end, and finally through the posterior layer of the ligalllent but behind the tubal openings. The incision in the uterus is closed and a typical vaginal fixation performed so that the uterine incision becomes extraperitoneal. J. P. GREENHILL.