A practical treatise on midwifery : exhibiting the present advanced state of the science / by F.J. Moreau ; translated from the French by Thomas Forrest Betton and edited by Paul B. Goddard.

  • François-Joseph Moreau
Date:
1844
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Licence: Public Domain Mark

Credit: A practical treatise on midwifery : exhibiting the present advanced state of the science / by F.J. Moreau ; translated from the French by Thomas Forrest Betton and edited by Paul B. Goddard. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    Chopart* says, he found in a wqman of fifty years of age nearly the whole uterus with its dependencies projecting through the lefl LnguinaJ ring. In the Memoirs of the Medical Society of Emulation,! Lallemand has reported the case of a washerwoman who died at the - mere, at the age of seventy-one, who for twenty-one years had a right inguinal hernia. On opening the body, in a very thick hernial sac the whole of the uterus with its right tube and ovary was found, and the left tube and ovary closely applied to the external part of the ring. The vagina, dragged by the uterus, was slighly oblique, and compressed the bladder against the pubes. The upper part of this canal, as well as the os tincse, had also protruded through the ring. The same author has reported, in the Bulletins of the Faculty of Medicine,:]: another case of crural hernia of the uterus, observed likewise in a washerwoman, eighty-two years of age, who died in the same hospital in 1815. In this woman the hernia had existed for forty years, and the uterus, accompanied by the ovaria, fallopian tubes, a portion of the vagina and omentum, and by two cysts, or probably hydatids, had escaped from the abdomen by passing beneath the right crural arch. From these facts, it is evident that the uterus when empty may protrude through the natural apertures of the abdominal parietes. Although sterility generally follows so considerable a displacement, yet we may say that it is not an inevitable consequence. Michael Doring relates, from Sennert,§ the history of Ursula, the wife of Martin Opitz, a cooper, who, whilst assisting her husband to bend a green pole in order to make a hoop, let it fly; one end struck her in the left groin. In a short time a small tumour appeared, which soon increased in size : five or six months afterward the motions of a child were distinctly felt in it. The pregnancy progressed: having arrived at its termination, the woman could not be delivered naturally: the operation of hysterotomy was performed, and a living child extracted. The mother survived only twenty-five days. Doring adds, I have seen this child, now two years old, in this present year of 1612. It is strong, but small for its age. On the right of one of the eyes, on the forehead, is a certain cicatrix, proceeding undoubtedly from a small wound made when performing the Csesarean section. The same Doring, in a second letter to Hildanus,|| relates the following case : « There was a poor woman at Niesse, a town of Silesia, who cohabited fifteen years with her husband, and had by him nine children. In her first labour she was abandoned by the midwife and assistants, on account of her great impatience, and peevish temper, so that she was delivered without any help ; and she was well aware that there was something wrong in her belly, although she had children afterward, with natural and fortunate labours. But soon after the embarrassment left by the first parturition, she several times felt as if something wanted to escape from her belly by the left groin, which was pretty large; being in trouble, she first consulted her husband, and then some women, who advised her to put her trust in God. Nevertheless, the tumour increased daily, so as to resemble a bull's bladder distended with wind, and became so large as to descend to her knees; by other signs it was afterwards found that it contained a child; she suffered great pain either in the sitting or recumbent position, being obliged to move the sac from side to side, in order to obtain relief. The time of her delivery being near, the town council, on account of her poverty, took care of her, and placed her in the hands of skilful physicians, surgeons and midwives, who, after mature deliberation, saw that there was no chance for a delivery per vias naturales, and that the mother and child could only be saved by opening the tumour- this opinion was communicated to the poor woman, in which she willingly acquiesced: the tumour was opened, and a healthy child extracted with some difficulty. The mother died in three days after the section, after suffering acute agony, and the child lived for six months. Can the uterus, when distended by the product of conception, protrude, and form a hernia ? Although SponiusTT and Ruysch have given cases of this accident, we cannot consider the facts related by these authors as belonging to hernia, properly so called: they seem to us to constitute an actual eventeration, owing undoubtedly to a separation of the linea alba, since the mere elevation of the tumour suffices to reduce it, and that, without any other assistance, the delivery was terminated per vias naturales. Causes.—The predisposing causes of hernia of the uterus are the relaxation of the ligaments of the organ, that of the natural apertures of the lower belly, the weakening or contusion of the linea alba, or of the abdominal muscles. The active or proximate causes are all violent efforts, or the existence of an old rupture. Signs.—They are as follows: this hernia generally occurs in the most depending part of the abdomen ; it appears under the form of a hard tumour, more or less voluminous, pyriform, with a pedicle narrowed toward the rings or the belly. This tumour, according to the healthy or morbid state of the uterus, is very painful, or has but little sensibility. In all cases, strong compression occasions suffering and sometimes fainting. It might be mistaken for omental or intestinal hernia, but will be easily distinguished by its greater hardness. By the touch we find the vagina elongated, contracted, and turned toward the tumour: when the hernia is complete, the os tincEe disappears, or its lips alone are engaged in the aperture which affords it a passage. In cases of conception, the progressive augmentation of the tumour relatively to the development of the uterus at different periods of pregnancy, the motion of the foetus about the fourth or fifth month and the stethoscopic signs leave no doubt as to its nature. Prognosis.—If the hernia is simple, if it occurs in the unimpregnated state, the prognosis is generally favourable ; it is more serious, if it is complicated by the presence of a portion of the bladder, omentum or intestine, if there are adhesions, if strangulation be threatened^ or if the woman is not beyond the age of child-bearing: it is very unfavourable if the woman has conceived, and at the same time the hernia is irreducible. Treatment.—It consists, 1st, to reduce the hernia if possible, and to keep it in that situation; 2d, to operate if there is stran°Tilation; 3d, to perform hysterotomy, if, the woman being pregnant, the child cannot be expelled per vias naturales. Consequently, we must endeavour to reduce the tumour by placing the patient in a suitable position, and by the gentle use of the taxis. When once restored it should be maintained in its place by a truss. When the reduction is impossible on account of the adhesions, size of the tumour, or any other cause, it must be supported by a napkin, a suspensory bandage, or any other appropriate means, unless symptoms of strangulation » Traite des Maladies Chirargicales, torn. ii. p. 305. Paris, an. iv. -f Troisieme annee, p. 323, in-8. Paris, an. viii. - Tom- v- P- l> el se1- § Observations Chirargicales de G. Fabri de Hilden. Obs. c, p. 456.