Vol 6, No 6 (1892)

Uterine rupture is one of the most dangerous birth accidents that an obstetrician can deal with. Despite the successful development of research on uterine ruptures in the last 15 years, we, unfortunately, are not yet in a position to foresee a rupture in every case. Only in cases that correspond to Bandl's theory can we really predict, under certain conditions, a break, although here, too, individual motives play an important role.

One of the most important questions for any practicing physician is what to do in cases where the body is at risk of fatal bleeding? The importance of this issue is evident, on the one hand, from the fact that it occupied the minds of such researchers as V. Lewins, King, Lower, Graily Hewitt and others in England, - Conheim, Kronecker, I. Sander, Bischoff, Kästner, Ponfick, Panum, Falck, Sahli, Leichtenstern and others in Germany, —Jolyet, Laffont and others in France, - Tarkhanov, Chudnovsky, Buyalsky, Chiriev, Sutugin, Nikolsky, Kolomnin, Ott and many others in Russia.

On October 24, 1889, a patient, Praskovya Sergeeva A., 46 years old, came to me on the occasion of severe bleeding, which the patient has very often recurs, for already a year.

25 people were present.

Mackenrodt presented a case of a bilateral tubal pregnancy, which he operated on with good success in November 1891. A 32-year-old patient, 6 years ago, got married for the first time and in the course of three years of her marriage gave birth 2 times safely and once there was a miscarriage. Since then, she was no longer pregnant. After the death of her first husband, she remained a widow for 2 years, then remarried. In May 1890, the regulations were absent, in June there were irregular bleeding and severe pain on the right side, and the temperature rose to 40 °. The doctor diagnosed a right-sided ectopic pregnancy.

Mrs. X., 35 years old, menstruation at 17 years old, married, gave birth twice and the last birth was 12 years old. ago. Menstruated correctly after four weeks. The last regulations were in October 1890; gradually the abdomen increased in volume, fetal movements appeared. After 10 months, after the last menstruation, on August 16, 1891, she felt severe abdominal pain, fetal movements stopped. On September 1st, a watery expiration appeared from the genital canal. The patient asked for medical help and Dr. Gramm, having examined the patient, found: the abdomen is strongly and unevenly stretched; a dense tumor is felt on the right.

With the frequency of uterine myomas, they are rarely obstacles to childbirth, since with large myomas most of the conception does not occur, with small ones, there are usually miscarriages. Low-sitting submucosal and intermuscular myomas create mechanical obstacles for childbirth, higher located ones cause irregularities of attempts, delay in child's place and bleeding, while a small subperitoneal, sitting on a thin leg of myoma, does not represent obstacles for childbirth.

Having listed the indications for Porro's operation, noting the important role that osteomalacia plays among these indications and citing Fehling's statistical data in favor of the beneficial effect of Porro's operation on the cure of osteomalacia, the author cites a case of pregnancy in a VIII-giving woman with a pronounced osteomalacia. The process began from the time of the 6th pregnancy, 5 years ago; at the end of the 7th pregnancy (childbirth lasted a long time, but ended by the forces of nature), the patient could no longer walk, and by the end of the 8th pregnancy, the pelvic deformity was so strong that per vias naturales it was impossible to extract even a crushed fetus.

The reason for the formation of an external blood tumor is mechanical damage to the head during childbirth. These injuries often occur when high forceps are applied, when, after bringing the head into the pelvic cavity, the forceps spoons are moved from the transverse to the oblique size of the pelvis. Under these conditions, the soft parts of the head and pericranium are easily kneaded, and the result is cephalhaematoma. To avoid this, the author does not move the forceps spoons, but, after bringing the head down into the small basin, removes the forceps, and then applies them again in the required oblique size. Difficulty in the introduction of the front spoon is easily eliminated if the spoon is inserted with the handle strongly lowered.

Mrs R., 26 years old, married for 2 years; regulation from 20 years through 4-5 weeks. Kyphosis, she says, is a consequence of childhood abuse. From the time of marriage, the menses became much stronger, as if from a cold, there were pains in the abdomen and sacrum, which ceased after Secale and Hydrassit. Beli. When examined: anemic, short in stature, with a moderately developed muscular system. The sleeve is wide; small, flaccid, malformed pharynx in the fornix; there is no vaginal part; the uterus is palpable unclear, in retroposition and retroversion. In the mirror, in addition to the aforementioned pharynx, there is also another, 2 cm from the first to the right, also without a vaginal part, flaccid and irregular.

Vondergoltz, using lysol since 1890 in obstetric practice and in various operations, considers this remedy to be a very important invention. Lysol has strong antiseptic properties and, due to its non-toxicity, deserves preference over other antiseptic agents.

The author in 11 cases of uterine myomas had the opportunity to apply the Apostoli method. In 8 cases, this method of treatment was used for long-lasting bleeding, and one patient underwent castration in 1887, in 3 cases, for severe pain and symptomatic complaints.

The literary department of my work has elicited several remarks from Dr. Zamshin, to which I consider it necessary to make objections.