Vol 9, No 9 (1895)

M.m. G.G.! Taz, which I have the opportunity to show you and which is one of the precious copies of the collection of pathological pelvises of the obstetric clinic of St. Vladimira, belongs to the patient K — b, who came to the clinic for eversion of the urinary bladder (ectopia vesicae). This patient had already been demonstrated in our Society by Dr. V.N. Gogotsky in the spring semester of 1894. I intend to demonstrate to you only the pelvis of this patient, which is of significant scientific interest, as well as casuistic, as extremely rare encounter. The question of the treatment adopted in this case will be sorted out in another place).

Mm. Yy! Over the past time, you have never had to observe during practical work in the Likhachevsky maternity hospital, the difficulty of childbirth, because of the wrong positions or wrong turns of the baby during childbirth. So, you saw the transverse position of the fetus during childbirth, the irregular cranial, cranial with the presentation of the handles of the fetus, requiring the intervention of art for the end of childbirth; they also saw not how the posterior types of cranial positions during childbirth did not go into the anterior, but the birth took place with the back of the fetus facing backward, causing more or less difficulty in childbirth, sometimes also requiring the intervention of art; Finally, you have not seen cases when the presenting head of the fetus during childbirth did not make the proper turns, or made incorrect, sometimes excessive, and in many of these cases you observed a very early appearance of signs of intrauterine asphyxiation of the fetus, which began to be difficult to explain and did not for the salvation of the baby of the immediate end of the delivery by an operative way. Undoubtedly, such cases raised in you first of all the question of why they happened, why they were caused and why they could not have been prevented, were foreseen and would have been normal for the course of labor in such cases. I wish to sort out the ethology of these irregularities in the present section and then give you answers to questions that arise involuntarily.

Attended by: honorary member K.F. Slavyanskiy, 32 members: Vertsinskiy, Viridarskiy, Grinev, Dolinskiy, Dranitsyn, Zamshin, Kakushkin, Lichkus, Mazurkevich, Massen, Matsevskiy, Radievich, Misevich, Pietskiykovych, R. Rutkovskiy, Rkmsha, Savchenko, Sadovskiy, Salmanov, Serezhnikov, Sitsinskiy, Stelmakhovich, Stravinskiy, Stroganov, Tereshchenko, Ulrikh, Fisher, A.R., Shverdlov, Stolts, Schuttenbakh and 20 guests.

Attended by: D. A. Abuladze, M. A. Voskresenskiy, D. A. Vorobiev, V. N. Gogotskiy, N. S. Grzhibovskiy, N. M. Zvinyatskiy, P. Yu. Krol, D. A. Karra, G. G. Levitsky, E. E. von-Meister, G. F. Pisemsky A. A. Redlikh, N. V. Untilov, N. V. Shuvarsky, S. M. Yarovoy, A. P. Yakhontov and 38 guests.

Before the operation, the patient was diagnosed with uterine fibroids, which had grown into the broad ligament, but during the womb it was found that it was a cyst with purulent contents. She was operated on in two ways: first, it was sewn into the wound, and then it was opened and emptied. After the operation, recognition fluctuated between the broad ligament cyst and between the expanded tube. The wall of the cyst was not examined microscopically, but the lengthening of the uterine cavity, the absence of interception between the uterus and the tumor, and the considerable size of the tumor made the author recognize a broad ligament cyst here.

In tѣh г cases, where during childbirth weakness of pushing can be expected, the author tries to give during the last 6-8 weeks, with a break, strychnine at 0.002-0.0025 twice. day. Until now, he has used this remedy in 16 pregnant women, and only in two (first-pregnant women) labor was slow. In all the rest, with the usual weakness of attempts, with chronic metritis, with fibroids of the uterus, with suffering of the appendages (hysterical), with a sagging stomach, in a syphilitic woman, childbirth proceeded quickly and completely correctly.

1st case. 20 years old, recently married. Coitus has never been successful. Besides fleshy, with a small hole, hymen in the usual place, sntm. 1-2 higher, in the vaginal cavity, there is a transverse septum with a hole that barely passes the end of the little finger. Lateral cuts of the outer septum were made and the posterior flap formed in this way was cut out; the wound was closed with knotty sutures. The ring is scattered on the narrowed place of the vagina. Systematic expansion of iodoforms. gauze. Convalescence.
2nd case. 45 years old, nulliparous. Coitus was never accompanied by pain, but the patient almost constantly suppresses the secretion from the vagina. The hymen, thick, with a very small opening, is pressed into the vaginal cavity, thanks to 29 years of married life, but not torn. Haematocolpos. Two side cuts; the edges are cut and sewn.

Wanting to test Makaveev's observations on the indifferent and beneficial action of warm baths during the month, the author exposed the action of salty baths in 27 ° -28 ° menstruating women on the Slavic mineral waters and describes briefly seven such baths. Conclusions from the last ones are as follows: common salt baths at 27 ° -28 ° R. With the addition of several buckets of lye, they do not produce any bad effects, on the contrary, they even quench pain, and the amount of blood lost either does not change, or decreases. Another series of observations by the author dulal with general or zone warm baths at 31 ° -33 ° R., without the addition of salt; From five observations the author concludes: in women with a normal sexual apparatus, baths at 32 ° -33 ° R., lasting 20 minutes, do not produce any harmful effects on the course of regulation and even reduce the amount of blood lost. In the third row (21 cases), the observation of the effect of baths on menstruating, with inflammatory changes in the pelvic organs, the same result was obtained: baths do not increase blood loss, sometimes they reduce the amount of blood lost, and what is most important, they are effective.

A child of 8 days, named by a woman's name, has only one irregularity in the structure of his body: the labia majora are enlarged and each contain an oblong body (testicles); small lips strongly developed; in the place of similarity of them - a pointed formation with a length of 1 cm., a width of 1/2 cm., without a hole. 1/2 sntm. posterior to this formation there is an opening with a pinhead, which expels both feces and urine. The holes of the anus in the usual place are nѣt. The author calls this deformity: pseudohermophroditismus externus masculinus cum atresia ani vaginalis.

When a 28-year-old woman who had died of putrefactive peritonitis was opened, an opening was found in the small intestine (at the border of the lean and ileal), communicating with the abdominal cavity and with the cavity formed into the omentum. In the hole protruded a bone with teeth - the remains of a teratoma. The gland cavity is connected to a cord that goes directly into the left Fallopian tube. The author believes that at the known time of uterine life, the left tube with the ovary, in which the teratoma developed, did not descend into the pelvis, but grew to the omentum and overgrown with it; the bone of the teratoma with constant pressure ulcerated the wall of the adjacent intestine.

The author lists several cases of vaginal foreign bodies described in the literature. There are two of his own cases. In a 39-year-old woman who gave birth, a cork was removed from the vagina, 5 cm long, 3 cm wide, with a hole at one end (probably intended for sticking on a stick - with the aim of greater convenience during masturbation). The patient has purulent colpitis. A torn rubber spur was removed from a 22-year-old woman.

The patient on the second day after childbirth, having urinated on his haunches, covered up the protrusion from the anterior passage of some kind of body. Believing that these were the remnants of the past or shells, she took the first knife that came across and cut off everything that protruded. The next day, she covered up the involuntary leakage of urine. The author found in her a vesicovaginal fistula, passing the end of the finger, and gangrenous disintegration of the vaginal wall; the patient was very feverish. In the course of a month, anti-rotting irrigation of the vagina and constant catheterization were applied. During this time, the patient recovered and her fistula closed.

The operation was made by Ya. A. Muzhenkov. Patient 25 years old, giving birth. Cut along the white line. Ovarian cyst with a thick leg, which directly passes into the broad ligament. Splicing with an oil seal. The leg is tied first with five ligatures, then with two; sheathed with a peritoneum; pinched with pulp, reinforced in the abdominal wound. After the operation, once the temperature was 38.4 °. Zhom fell off on the 20th day. Convalescence.

1st case. 50 years old, multiparous. 6 years ago, the climacteric period began. 3 months ago, the tumor covered up in the belly. Cystoma ovarii sinistri recognized. Gluttony on January 8, 1894. The cyst was opened with a knife. There are no splices. The cut surface of the leg is sheathed with a peritoneum. Recovery. The tumor turned out to be a multichamber colloid cyst of the left ovary.

10-raga, 42 years old. The mouth is perfect, the waters have departed; the head is fixed in the entrance. Contractions are weak and slightly painful. The fruit is alive: the second parietal position. The general condition of the woman in labor is completely satisfactory. The author rѣshil wait. After 6 hours, the patient was found in a state of collapse. Fight nѣt. The head is higher and mobile. I recognized the rupture of the uterus and proceeded to perforate the head, but when manipulating the piercer, the head moved up even more. An attempt to make a turn for some reason failed. The author is silent about the further.

A 20-year-old girl, so obese that her parents, with whom she lived, did not suppress her pregnancy, which had reached a normal term, suddenly fell ill with a headache; at night she had convulsions. The invited doctor found her in an unconscious state; seizures of convulsions were 3-4 times per hour, more tonic than clonic in nature, the tongue was bitten, the pupils were dilated. The doctor suspected poisoning with some kind of alkoloid. In the morning the patient died without being destroyed. Two women, who washed the deceased and laid her on the table, did not suppress her child's emergence; they covered her with a sheet, which there was no reason to reveal for two days, until the forensic medical examination of the corpse by Dr. Green. The last one, having removed the sheet, saw that between the legs of the deceased lay a dead newborn child, legs down, with the head at the mother's genitals, that is, with the buttocks presented; a fleshy round mass protruded from the genital organs of the deceased, which turned out to be the bottom of the uterus turned upside down and not separated from it after the house; the umbilical cord was very short. Traces of bleeding or clots were not detected. The perineum of the parturient woman was torn. Her belly was very swollen, and when she was punctured, a huge amount of gas came out of it. There were no pathological phenomena in the organs of the abdomen and chest. Strychnine was not found in the stomach and intestines sent to the chemical laboratory.

O'Sullivan has performed a number of large gynecological surgeries in recent years. The outcomes of the operations were very favorable, but the numbers of recovery are not shown.