File:A textbook of obstetrics (1899) (14755271466).jpg

Identifier: textbt00hirs (find matches)
Title: A textbook of obstetrics
Year: 1899 (1890s)
Authors: Hirst, Barton Cooke, 1861-1935
Subjects: Obstetrics
Publisher: Philadelphia : Saunders
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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ydifficult. In one of my cases, seen in consultation, five dayshad elapsed since the womans delivery. She had suffered greatpain, had considerable fever, with a foul discharge, and hada very rapid pulse, yet no vaginal examination had been made,although the patient was in charge of a professed expert ingynecology ! I found the womb completely inverted. Repo-sition was accomplished, after most fatiguing exertion, by the fol-lowing plan : One hand, made into a cone shape, was inserted in 568 THE PA Tin)LOG ) OF IAHOR. the vagina and the finger-tips were pressed steadily against oneside of the lower uterine segment, forcing it into the cervicalring. After steady pressure for almost an hour, the cervix yieldedconsiderably. Then an assistant helped in the dilatation ofthe cervical ring, in the manner shown in figure 447, and at thesame time made counterpressure downward upon the cervix.The womb was returned to its natural position shortly afterthis manceuver was tried. The woman recovered.
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Fig. 447. — I, Complete inversion of tin- uterus; 2, fust manceuver to reinverlthe lower uterine segment; 3, second manoeuver to widen cervical ring ami affordcounterpressure by an assistant. Prognosis.—The mortality of inversion of the womb hasbeen extremely high. In one series of 109 cases there were(So deaths, and 72 of these within a few hours after labor. Inanother series of 54 cases there were 1 2 deaths (Winckel). Thethree cases under my care recovered. The causes oi death are:shock, hemorrhage, sepsis, peritonitis, and exhaustion from long-continued loss of blood. LABOR COMPL It.-/ TED BYAC( IDENTS AND DISEASES. 569 Rupture of the symphysis occurs not infrequently,1 usually in consequence of some disease within the joint itself, occasionallyas the result of great force in the extraction of the head with for-ceps or after version. The accident may be recognized at thetime of its occurrence by feeling the bones give way, or by actu-ally hearing them snap. Hut it may not be d

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