Anomalies and Curiosities of Medicine [58]
delivery of a dead child with a bullet in its abdomen. Labor was normal and the internal recovery complete. Von Chelius, quoting the younger Naegele, gives a remarkable instance of a young peasant of thirty-five, the mother of four children, pregnant with the fifth child, who was struck on the belly violently by a blow from a wagon pole. She was thrown down, and felt a tearing pain which caused her to faint. It was found that the womb had been ruptured and the child killed, for in several days it was delivered in a putrid mass, partly through the natural passage and partly through an abscess opening in the abdominal wall. The woman made a good recovery. A curious accident of pregnancy is that of a woman of thirty-eight, advanced eight months in her ninth pregnancy, who after eating a hearty meal was seized by a violent pain in the region of the stomach and soon afterward with convulsions, supposed to have been puerperal. She died in a few hours, and at the autopsy it was found that labor had not begun, but that the pregnancy had caused a laceration of the spleen, from which had escaped four or five pints of blood. Edge speaks of a case of chorea in pregnancy in a woman of twenty-seven, not interrupting pregnancy or retarding safe delivery. This had continued for four pregnancies, but in the fourth abortion took place.
Buzzard had a case of nervous tremor in a woman, following a fall at her fourth month of pregnancy, who at term gave birth to a male child that was idiotic. Beatty relates a curious accident to a fetus in utero. The woman was in her first confinement and was delivered of a small but healthy and strong boy. There was a small puncture in the abdominal parietes, through which the whole of the intestines protruded and were constricted. The opening was so small that he had to enlarge it with a bistoury to replace the bowel, which was dark and congested; he sutured the wound with silver wire, but the child subsequently died.
Tiffany of Baltimore has collected excellent statistics of operations during pregnancy; and Mann of Buffalo has done the same work, limiting himself to operations on the pelvic organs, where interference is supposed to have been particularly contraindicated in pregnancy. Mann, after giving his individual cases, makes the following summary and conclusions:--
(1) Pregnancy is not a general bar to operations, as has been supposed.
(2) Union of the denuded surfaces is the rule, and the cicatricial tissue, formed during the earlier months of pregnancy, is strong enough to resist the shock of labor at term.
(3) Operations on the vulva are of little danger to mother or child.
(4) Operations on the vagina are liable to cause severe hemorrhage, but otherwise are not dangerous.
(5) Venereal vegetations or warts are best treated by removal.
(6) Applications of silver nitrate or astringents may be safely made to the vagina. For such application, phenol or iodin should not be used, pure or in strong solution.
(7) Operations on the bladder or urethra are not dangerous or liable to be followed by abortion.
(8) Operations for vesicovaginal fistulae should not be done, as they are dangerous, and are liable to be followed by much hemorrhage and abortion.
(9) Plastic operations may be done in the earlier months of pregnancy with fair prospects of a safe and successful issue.
(10) Small polypi may be treated by torsion or astringents. If cut, there is likely to be a subsequent abortion.
(11) Large polypi removed toward the close of pregnancy will cause hemorrhage.
(12) Carcinoma of the cervix should be removed at once.
A few of the examples on record of operations during pregnancy of special interest, will be given below. Polaillon speaks of a double ovariotomy on a woman pregnant at three months, with the subsequent birth of a living child at term. Gordon reports five successful ovariotomies during pregnancy, in Lebedeff's clinic. Of these cases, 1 aborted on the fifth day, 2 on the fifteenth, and the other 2 continued uninterrupted. He collected 204 cases with a mortality
Buzzard had a case of nervous tremor in a woman, following a fall at her fourth month of pregnancy, who at term gave birth to a male child that was idiotic. Beatty relates a curious accident to a fetus in utero. The woman was in her first confinement and was delivered of a small but healthy and strong boy. There was a small puncture in the abdominal parietes, through which the whole of the intestines protruded and were constricted. The opening was so small that he had to enlarge it with a bistoury to replace the bowel, which was dark and congested; he sutured the wound with silver wire, but the child subsequently died.
Tiffany of Baltimore has collected excellent statistics of operations during pregnancy; and Mann of Buffalo has done the same work, limiting himself to operations on the pelvic organs, where interference is supposed to have been particularly contraindicated in pregnancy. Mann, after giving his individual cases, makes the following summary and conclusions:--
(1) Pregnancy is not a general bar to operations, as has been supposed.
(2) Union of the denuded surfaces is the rule, and the cicatricial tissue, formed during the earlier months of pregnancy, is strong enough to resist the shock of labor at term.
(3) Operations on the vulva are of little danger to mother or child.
(4) Operations on the vagina are liable to cause severe hemorrhage, but otherwise are not dangerous.
(5) Venereal vegetations or warts are best treated by removal.
(6) Applications of silver nitrate or astringents may be safely made to the vagina. For such application, phenol or iodin should not be used, pure or in strong solution.
(7) Operations on the bladder or urethra are not dangerous or liable to be followed by abortion.
(8) Operations for vesicovaginal fistulae should not be done, as they are dangerous, and are liable to be followed by much hemorrhage and abortion.
(9) Plastic operations may be done in the earlier months of pregnancy with fair prospects of a safe and successful issue.
(10) Small polypi may be treated by torsion or astringents. If cut, there is likely to be a subsequent abortion.
(11) Large polypi removed toward the close of pregnancy will cause hemorrhage.
(12) Carcinoma of the cervix should be removed at once.
A few of the examples on record of operations during pregnancy of special interest, will be given below. Polaillon speaks of a double ovariotomy on a woman pregnant at three months, with the subsequent birth of a living child at term. Gordon reports five successful ovariotomies during pregnancy, in Lebedeff's clinic. Of these cases, 1 aborted on the fifth day, 2 on the fifteenth, and the other 2 continued uninterrupted. He collected 204 cases with a mortality