Vol 9, No 7-8 (1895)

Tumors of the ovaries in general and dermoids in particular do not particularly complicate a normal pregnancy, causing the last more or less inconvenience.
All ovarian tumors, with the exception of dermoid tumors, differing in relatively large sizes, generally speaking and with the exception of very bulky tumors, lessen the development of pregnancy and especially the course of labor, since these tumors have a tendency to grow upward into the abdominal cavity, thus being removed from small pelvis.

Unfortunately, we do not yet have accurate statistics of malignant neoplasms of the ovaries. Virkhov, for example, of the opinion that they are quite rare. In Schroeder's 600 cases of neoplasms of the ovaries, there are only 10 cases of malignant, consequently somewhat more than 1%. Wert in relation to ovarian cysts determines the frequency of dense neoplasms in 5%. Spencer Wells initially rose 1.72%, followed by even less 1.2%. Leopold), from a more distant time, there are only 8 cases of malignant neoplasms of the ovaries: 4 cases of Spencer Wélls, of which two were fatal, two cases of Spiegelberg, both were fatal, one case of Buren and one recovered a rural doctor whose patient died of a collapse shortly after the operation. Even if we assume that cases of malignant neoplasms of the ovaries are quite rare, then all the same, judging by the latest reports, it cannot be argued that this rarity would be in such a scale as the authors just cited for a longer time estimate it.

Three cases are described: 1) Multiparous, 28 years old. A miscarriage at 4 months of pregnancy, with inflammation of the lung, after a shaking edema. After labor, I was separated the next day. A small piece of it could not be separated by fingers or a spoon; he stood out when the uterus was washed on the 5th day. When endometritis occurs, death is on day 20.

Peasant woman 35 years old, gave birth twice. Four years ago, being pregnant, she suffered some kind of fever, after some time after which she began to discharge pus from her genitals, and then the bones, which continues throughout these four years. The patient is emaciated, feverish at times. The fundus of the finger is 4-5 above the pubis; the uterus is in the bend back, mobile; with pressure on it, a crunch is felt in it. The appendages and peri-ocular spaces are healthy.

This hospital also provides assistance to gynecological patients. During the reporting period, 717 operations were performed in her outpatient clinic, including 17 gynecological operations (discisio coli uteri 2, excisio condylomatum 11, removal of cervical polyp 3 and removal of cervical cancer 1).

The maternity hospital has six regular beds, but it provides assistance to a greater number of women than the number corresponding to the provision. The house has a midwife school. In 1892, 366 women were assisted, of whom each spent an average of 6, 3 days in the house. Most often there were peasant women, burghers, soldier women, servants and dressmakers. The number of married women was 71.6%; unmarried 28.4%. Primordial women accounted for 31.6%. There were 307 urgent births. Twins 4. The ratio of the number of boys to the number of girls = 1.1: 1. Stillborns accounted for 5.3%.

In contrast to Sänger, the author declares that it is necessary to treat gonorrhea in women vigorously in the acute period of illness, not being limited to one absolute rest of the patient in bed. This treatment should be directed to the inner surface of the uterus, which plays an important role in the perception and spread of the breakthrough infection. From the mass of means suitable for such a treatment, the author chose aluminol, in view of its properties, without destroying tissues, deeply penetrate into their thickness.

The author points out the absence in some cases of rupture of the uterus of such seizures, which are usually considered cardinal. In his case, in the second-bearing, 37 years old, (the first birth was 10 years ago), urgent labor proceeded with mild pains, the forward movement of the presenting part (head) went quite quickly and easily; the ring of contraction was not expressed.

Married and childless. She never had a month, but every month her usual peeling of the cuticle of her entire body intensified, and her head hurt for 3-4 days. Sexual intercourse has always been indifferent.

On the basis of one own observation, in which an inversion was formed without any external violence, as well as a hundred cases collected from the literature of the last years, the author comes to the conclusion that an independent inversion is not at all so reliable as it is used to think on the contrary, but that he more often than violent.

A 44-year-old woman, VI para, in whom all previous births due to the narrowness of the pelvis ended with the help of art, was shattered, 13 hours after the release of abundant water, turning on her legs with incomplete opening of her mouth and weak pains. At the very moment when the knee appeared at the external genital parts, Sch. heard peculiar sounds emanating from the uterus. Having released the leg from his hands, he began to listen, putting his ear to the uterus; however, he did not hear any more sounds, but at the same time with correct heart tones he clearly felt the respiratory movements of the fetus.

1) A severely emaciated multiparous woman, who had the last regulation 8 months ago, complains of pain, and lately on bleeding. Due to the undetermined nature of the tumor felt in the abdomen, the diagnosis fluctuates between missed labor and gravidatas extrauterina. Probing the uterus, which turned out to be empty, raises doubts. But earlier, after the consent of the patient, who was in a very feverish state, at the proposed surgical intervention, a stinking amniotic fluid began to seep through a small opening in the vagina. Having widened this hole, we began to extract the contents of the fertile beetle, which did not end immediately, but lasted for several days at intervals. Convalescence.

The cases of tetynia observed by the author at the Schauta clinic deserve special attention mainly because in these cases a new symptom, which has not yet been described, appears on the scene: it must be because in both cases tonic convulsions or hyperesthesia appeared in all fingers arbitrary or artificially induced uterine contractions.

The results achieved at the Budapest Clinic clearly show that if hygienic and pharmaceutical processes have a beneficial effect on osteomalacia, then castration in any case belongs to the palm in a number of therapeutic cases, which are not even possible with the help of this action of other means.

Having transferred the history of the disease 6 cases of osteomalacia, in which castration was performed (in 5 cases), resp. operation Porro (in 1 case), the author is trying to throw some light on the ethiology, pathogenesis and therapy of this suffering.

The author did not find in the literature a description of the case of this so-called round, irritating Clarke ulcer, observed in a living woman. His case concerns 37 years old, giving birth, a woman who fell ill a year ago with pain and pain during urination. The author found her swelling and soreness of the opening of the urethra and the anterior edge of the vaginal opening.

N. made a temperature measurement in 100 newborns during December 1894 and January 1895 at a midwife school in Danzig. Temperature was measured in recto 2 times a day, in suspicious cases up to 3-4 times at different times of the day. As a rule, measurements were made starting from the 3rd day.

The author cites the opinions of some authors, pointing out the inappropriateness of the Schultze method, for reviving a child with fractures of the collarbone, a heavy weight of the child, etc. K. subscribes to the opinion of Schultze that even under these conditions, careful lege artis performed by Schultze does not harm the child, accompanied by the usual quick elimination of asphyxia. Two cases of this kind are described in detail by him.

Based on their observations, the author comes to the conclusion. that such does exist. At 750 births in Brown's clinic (Vana), he observed these phenomena 7 times in both the first and the many-born. Of them 3 times during childbirth and 4 times during the last months of pregnancy.

A large malignant tumor of the liver, with the lower branch lying in the small pelvis.
When examined per vaginam, the uterus could not be accurately identified, nor could they prove the absence of a connection between the uterus and the tumor.

Attempts to engraft the ureter to the bladder have been going on for a long time and many times, but always with no success; Only recently Büdinger was able to get a favorable outcome in experiments on dogs in 2 cases, and Mauo even reports about such an operation on a human, but at the next analysis, Mauo's case cannot be recognized as belonging to this category.

The author reports two cases of vaginal cancer, operated by him in a manner similar to that described by Olshausen (See Journal of Obstetrics and Women's Diseases, January, 1895).

The author reports a case of finding sugar in the amniotic fluid of a diabetic patient. Her condition in the last days of pregnancy deteriorated sharply, while at the same time a fairly rapid increase in the abdomen was noticed. During labor, the amniotic fluid, which contained 0.3% sugar, was released with an artificial rupture of the bladder 4000.0.

The course and therapy of this case is so interesting that I will allow myself to give a detailed abstract of it. 30-year-old, first childbirth, delivered to the clinic in an unconscious state. According to relatives, she had 2 convulsive seizures during the last 2 hours. Soon after arrival, a new one came - the third seizure of convulsions, 5 minutes in duration, characteristic of eclampsia. The pulse rate is about 120 per minute, severe tracheal wheezing, foam at the mouth, deep cyanosis, soporosis. After some time, my condition improved somewhat. Pulse 96 beats, breathing 36 per minute — superficial. The catheter was delivered 30 ccm. concentrated, dark brown urine, containing 9 ‰, according to Essbach’y, protein, and in the sediment had numerous granular and epithelial casts.

The author could not find in the literature a case similar to that described by him. If an extremely rare closure of the intestinal lumen was observed before by the pressure of the ovarian cyst, this happened only when the leg was twisted the last day.

In two cases of extrauterine pregnancy of the first 2 months, D. with full success applied his method of vaginal cellotomy. The postoperative period proceeded in a high degree well, the first patient could get up on the 11th day, on the 12th she was shown to the society of doctors and on the 13th she was discharged in excellent condition. The 2nd patient got up on the 9th day and was discharged healthy on the 12th day.

Citing a fairly detailed review of the literature on this issue, the author comes to the conclusion that cysts in the uterus can be of two kinds: either as a retention formation from the glands of the uterine mucosa, or the remnants of the Wolf's ducts develop. In addition, similar formations were observed with a double uterine cavity, if atresia was present in one half and fluid accumulated in it (hydrometra or haematometra).

Without citing any new facts and data, W. in a short (and not entirely accurate) statement argues with Menge, comparing the data obtained by various authors who worked in this direction. He states the disagreements of the researchers, both on the issue of the maintenance of bacteria in shake-pregnant and non-pregnant women, as well as on the maintenance of pathogenic microbes in the genital canal.

The author, on the basis of numerous and long-term observations, speaks in favor of the treatment of such bends of the uterus forward with intrauterine pessaries, where there is only relaxation of the uterine tissue (without any inflammatory phenomena both in the uterus and in its usually wide enough cervix), and where the cervix is usually quite wide.

A 33-year-old, emaciated worker was sent by one doctor to the hospital with the diagnosis of an extrauterine pregnancy, 25 / ix 93. She had a previous birth 13 years ago, 3 years ago she had a 5 month miscarriage, the last regulations in April 93 she had pains in the abdomen with light bleeding; then she had morning sickness, swelling of her breasts. In August - the second attack of pain, lay for about a week in bed. Cullingworth, denying that she had an extrauterine pregnancy, kept her in the hospital until the pains soothed and for the 18th sent her home. 5 / I 94 she developed pain during labor with vomiting. The uterus was palpated not enlarged, without any discharge from her, a tumor in the abdomen with clear movements and heartbeats of the fetus. 13 / I the patient was again admitted to the hospital.

This issue was discussed at the annual meeting of the American Gynecological Society, May 29-31, 1894, and the majority of the members spoke out against this operation.

Since the extirpation of the uterus, making a woman sexless, has a bad effect on her psyche, Dudley prefers to excise only one tumor from the uterus, myoma.

Dr. Reinolds (Boston) raised this issue at the 19-year meeting of the American Gynecological Society. V. advises under ordinary conditions, that is, with anterior views and the need to accelerate labor, after the expiration of water - anesthetize the woman in labor and bend the head, with posterior views - turn on the legs; if it is impossible to turn or bend the head, forceps, even with posterior views.

Dr. Davis reported three fatal cases of vomiting during pregnancy. In the first of them, the pregnant woman suffered from gastric disorders before pregnancy; her vomiting was incessant and very exhausted her. She died at 2 months of pregnancy. Before dying, she developed a petechia-shaped spotty rash. In the second case, severe nausea and vomiting occurred at 3 weeks of pregnancy with severe pain and belching, locally: prolapsus and anteflexio uteri. The usual treatment. At 14 weeks, the anteflexed uterus was infringed at the bottom behind the pubis; the correction did not reduce vomiting. The expansion of the neck was accompanied by a slight improvement. It was decided to empty the uterus, which was done without difficulty and with minor bleeding. The patient, however, died soon after. An autopsy showed that the tissue of the uterine cervix was abnormally hard (fibrous); the uterus, ovaries, and tubes were normal; the blood was thin, fatty degeneration of the heart. In the third case, the patient, in addition to nausea and vomiting, suffered from severe pain in the epigastric region and vomiting had a coffee color. Everything possible was done, but nothing helped: the patient died.

1) Congenital cyst, emanating from the spine, as an obstacle to childbirth. In 30-year-olds, I-women in labor, the baby's head sank into the pelvic cavity, the cervix opened, but despite the good contractions, labor was delayed. Examining the pelvis of a woman in labor with his finger to find out the reason for stopping labor, Mueller felt a fluctuating tumor in the lower part of the sacral cavity, the size of a hen's egg. Dr. M .. checked the result of examination of the per rectum and found it more convenient to pierce the tumor with a test trocar from the rectum. In the fluid released from the tumor, the light, straw color turned out to be epithelial, cylindrical cells, indicating that the cyst was congenital (Eulenburg) and communicated with the cavity of the fetal spine. Childbirth ended with forceps, with great effort in the course of half an hour. The postpartum period went well.

A 28-year-old woman who gave birth to 6 times was sick in January 1891, typhoid with severe intestinal bleeding in February; after which she did not recover from her health before the operation. 21 / IV 91, she first diagnosed a tumor up to 4 inches thick and the same amount above the pubis.

Little is known about the origin of panophthalmitis in puerperas; even scientists like Playfair and Garrigues set out in their textbooks that a disease, starting from the conjunctiva, penetrates deeply, piercing the vitreous cornea and cornea.

In the first case, in a 21-year-old woman, milk began to come out of the breasts from the 2nd day after the birth and in such a huge amount that she was constantly wet. All sorts of means did not help in the first three months: belladona, iodide kaliy, ergotin, etc. More than other means helped: squeezing breasts and antipyrim with opium; last Smith appointed at the end of the 3rd month. Milk separation decreased immediately, apparently, without any influence of milk production. The amount of milk measured over the course of several days was 1/2 gallon (2 pounds?) + What the baby was sucking.

Out of the extensive, beautifully processed report, I will cite only a few sections of it, setting out new ways, although other sections are very interesting.

Case 1. 28 y., Lobular fibroids protruding from both sides of the uterus. Removal of the tumor with a part of the muscle fibers of the uterus with the opening of the cavity of the uterus, the remaining part of the uterus sewn, without drainage, recovery. Afterwards, pregnancy began, which ended in a successful resolution.

Mistriss Scharlieb performed 64 laparotomy, 20 of them - for myomas, are the subject of her report. From these 20 in 6 cases, the appendages were removed for the sake of stopping bleeding, in 13 - the tumor, uterus and appendages were removed, and in 1 - only the tumor. The first 6 recovered, the bleeding stopped in 5; of the rest, 14 two died from shock and 1 from a septic process.

Dr. Dorsett disputes with others the honor of the first application of the named method, referring to the production of this operation in 1889, about which he informed the medical society in St. Louis 17 / V 1890 and that was published by him in St. Louis Courrier of Medecine in the same year.

The named anomaly was observed in 2 sisters, which is why Ballantine admits that she was congenital to them.

From January 1892, Dr. Warral performed six operations for the removal of the uterus with a successful outcome. The age of the patients was 17, 32, 38, 39, 43 and 52 years old. One was unmarried, the rest were multiparous; bleeding before the operation lasted for many months in 5 and only in one - 3 years. A lot of lesions were: uterine heat in 3-x, cervix in 2-x, vaginal port in 1-m case; in the last day, the cancer moved to the posterior wall of the vagina, and in 2 cases of cervical cancer, the lesion spread from the outside to the parameters, from the inside, along the mucous membrane, to the uterus.