Vol 7, No 5 (1893)

(Read in the meeting of the Obstetric and Gynecological Society in Kiev, 1892).

Mm. Yy! Leaving aside the scientific side of the science of miscarriage, which has received a sufficient degree of development in modern obstetrics, I will allow myself to stop your attention on the purely practical side of this issue, concerning the therapy of miscarriage.

On February 12, 1893, the peasant woman Shimakova was admitted to the women's department of the Oryol provincial hospital with a complaint of the growth of her abdomen and severe pain in it. She gave birth to the first time 6 months ago. Childbirth is difficult, the child was born dead. After the birth of the ailment 3 weeks. Measurement of the pelvis was given by tr. 29, sp. 25 cr., 26, conj. ext.16.

There was an honorary member of the Academy A. If. Krassovsky, 37 members: Batsevich, Bidder, Blonsky, Viridarsky, Gavronsky, Hermonius, Danilovich, Dobradin, Dobrovolsky V. N., Dranitsyn, Zheltukhin, Zabolotsky, Zamshin, Zmigrodsky, lichkus, Martsynkevich, Massen, Mersh, Misevich, Ott, Polonsky, Porshnyakov, Rachinsky, Rodzevich, Ruzi, Rutkovsky, Salmanov, Stelmakhovich, Stravinsky, Strogonov, Fischer A. R., Chagin, Shverdlov, Stoll, Stolz, Eichfus, Yanpolsky and 25 guests.

26 members were present; Batsevich, Badder, Brandt, Vasten, Bertsinsky, Vorobyov, Hermonius, Grinev, Danilovich, Dranitsyn, Zabolotsky, Zamshin, Zmigrodsky, lileev, Massen, Ott, Ruzi, Savchenko, Sadovsky, Salmanov, Stravinsky, Strogonov, Urvich, Fisher A. R., eberman, Eichfuss And 8 guests.

In the first case, the patient deliberately concealed the history of her illness, deliberately gave inconsistent data and thereby made it extremely difficult to diagnose. When the rupture of the fetal beetle in the abdominal cavity was clear, the patient resisted any surgical intervention and died. In the second case, the rupture of the fetal baby also occurred in the abdominal cavity, blood poured out, accumulated in the Douglas space, and the evacuation of the blood cyst per vaginam ended in the patient's recovery. In the third, an accidental fetus ruptured in the broad ligament and the egg now died.

The patient, 33 years old, entered the Saint-Louis hospital (Paris) in August 1892, at the 3rd month of her pregnancy. Of the previous pregnancies, 3 ended in timely and completely correct childbirth, children are alive; The 4th pregnancy ended in stillbirth, which required the imposition of forceps. Before the end of the last regulation - profuse menorrhagia and mild leucorrhea. Was admitted to the hospital with complaints of very severe pain in the stomach. During examination, two tumors were found: one occupies the left fossam iliacam, goes over the navel and in its consistency resembles a pregnant uterus, another tumor, solid and much less mobile, lies in the cavity of the pelvic floor on the right side. Between these two tumors, the right personality, sensitive to pressure, is felt.

The author cited 40 cases of placentae praeviae completae observed in Paris hospitals. The autopsy results (8 of them were performed, of which 4 were performed by the author himself or in his presence) and clinical examination prove that a complete or central presentation of placentae undoubtedly exists. In such cases, the cervix turns out to be, contrary to expectations, a little tense, probably due to extreme vascularity, so that ruptures of the cervix during childbirth constitute a completely exceptional phenomenon. Prediction in placenta pravia completa is extremely unfavorable for the mother, but even more for the child: the mortality rate is 80% for children and 35% for mothers. The author considers cervical-vaginal tamponation, which can be done, by the way, by means of various kinds of balloons, as the best solution for treatment.

N. N. 21 years old, primary pregnant, suffers from bicuspid valve insufficiency. Starting from the 3rd month of pregnancy, the seizures from the heart, namely shortness of breath and palpitations, became more and more formidable. With the course of pregnancy, the patient's condition, in spite of all the therapeutic conditions, worsened more and more; the slightest movement of the patient caused her painful shortness of breath and palpitations.

The author speaks only of faradic current, and examines its threefold action on a pregnant woman: 1) a calming effect on the general nervous system, 2) excitation of muscle contractions, 3) the ability of faradization to prevent and stop uterine bleeding. Pharadic current is very useful when chloroform, chloral-hydrate or morphine are more unacceptable, because of idiosyncrasy or weakness of the patient, as long as the maximum doses of these drugs are achieved without a proper effect, finally, when all is excreted.

The author gives a detailed history of a patient suffering from a tumor emanating from the region of the sacral bone, the size of a child's head, dense fibrous consistency, so much narrowed the anterior-posterior size of the pelvis that the last one was barely 2 - ctm. Due to such a contraction, at the 6th birth, the subsequent head could not be removed, and, after decapitation, was left in the uterine cavity; three months later, the patient was admitted to the clinic of prof. Rake, and in the continuation of this time the bones of the skull of the detained head were arbitrarily protruded, which was accompanied by a feverish state.

The author describes a case in which, in his opinion, the removal of the handle was shown and necessary. This case is: a woman with a narrow pelvis, conj. ext. = 15 ctm; diagonalis = 10.5; gives birth to the 3rd connector; the first childbirth ended prematurely with a living child, the second - due to the failure of the fetus.

Prof. Morisani, who worked all his life to resurrect from the undeserved oblivion of the operas of the symphysis and pelvicotomy, in particular the symphysisotomy, insists on not mixing these two operations, on the indispensability of each other, as they are

Prof. Leopold, describing his two successful cases of symphysiotomy (Centralblatt für Gynec., 1892, No. 30), offers several modifications of the method of this operation, developed by the author

Ries dwells on two little touched upon questions concerning the development of the uterus in the postnatal period: how long does the inner mouth remain open, and on what conditions does more or less early closure of it depend, and how is the clinically reverse development of the place of the former postpartum expressed?

By this name is meant that kind of vaginismus, which is not accompanied by either excessive sensitivity of the vaginal opening, or a convulsion of the obturator muscle. This type of vaginismus consists in convulsive compression of the walls of the sleeve, depending on the reduction of m. levatoris ani. One such case was presented to the author's observation: an intelligent patient of 21 years old, complains of pain during copulation both with her and with her husband.

The patient, 23 years old, who never had menstruation, suffered from molimina menst. For 4 years, which have recently become stronger and more prolonged. The external organs and the vagina are normal, the neck goes up, forward and to the right, on the left above the neck there is a dense cord with a thickness of a finger, 3 cm long, going, gradually thinning, towards the left ovary, the size of a chicken egg; on the right in the ligament, a solid formation is felt, the size of a bob; the right ovary is dense, not enlarged, at the pelvic wall.

Persistent expansion of the canal of the uterine cervix in order to cure infertility or painful months began to be applied even from the beginning of the past century. But all the methods of discisionis portionis vaginalis proposed so far leave a lot to be desired and, according to Schroeder, “produce either too little or excessive enlargement of the external opening, always disfiguring the vaginal part”.