KING'S COLLEGE HOSPITAL

John Wood
1858 The Lancet  
530 day with a strip of lint, adhesive plaster, compresses, and roller as before, saturating the lint with the compound tincture of benzoin, instead of spreading the spermaceti ointment over it, as in the first dressing, and stimulating the edges occasionally with a strong solution of nitrate of silver. The uterine pain continued to occur in the afternoon, but becoming less, and coming on at a later period each day for a week after this date, when it disappeared entirely. It was always much
more » ... aged by two-grain doses of powdered opium, of which she had one each afternoon. On the 18th of March, she had a slight show of the menstrual discharge. On the 25th, she began to apply the infant to the breast, and in a few days after had a fair supply of milk for it. The cicatrix of the wound measures at present only four inches. For the first week, the patient was kept entirely on milk and farinaceous food, after which she had beef-tea, and in a few days was allowed a small quantity of mutton-chop. On the 4th of April, she got out of bed for the first time. Since then, she and the infant, a fine little girl, have frequently been in my surgery, and are at present in perfect health. May, 1858. I WAS called, at about half-past five on the morning of Sunday, January 31st, 1858, to attend Mrs. P-, aged thirtyone, the wife of a miner, residing in this town, in her fifth confinement. She is at best very pallid and chlorotic in appearance, extremely nervous, and has suffered previously from attacks of haemorrhage after labour, which have endangered her life. On the last occasion when I attended her, the uterus exhibited, after the removal of the placenta, great want of contractile power, and the discharge of blood was very excessive. Several of her relatives have, 1 understand, suffered from adhesion of the placenta, and haemorrhage ; and I have myself seen a sister of hers in the most feeble condition from loss of blood after labour. On examination per vaginam, I felt a bag of membranes protruding through the os uteri, which was dilated to the full extent. When a pain occurred, I ruptured the membranes, and there was expelled directly a living male icetus of between seven and eight months' growth. In ten minutes, another pain enabled me to reach a second set of membranes; these I also ruptured, and a second living male child was speedily born. Immediately succeeding the birth of this foetus, I was somewhat astonished and alarmed at a sudden rush of blood from the uterus, which completely deluged the bed, brought on a state verging upon syncope, produced great nervous irritability, and placed the life of my patient in imminent peril. After administering stimulants, applying ammonia to the nostrils, and carefully adjusting a bandage to the abdomen, I introduced my hand into the vagina, when it impinged upon, besides coagula, a third set of unruptured membranes. I broke through these, and a third foetus, much larger than the others previously born, was directly ushered into existence. Alarming haemorrhage again set in, and I immediately re-introduced my hand, when I found the placentae common to the two children first born firmly adherent to the uterus (fundus) for a very considerable extent; while the placenta of the third child was lying unattached in the uterine cavity, together with a large quantity of semi-coagulated blood. I tried in the most gentle manner to remove the attached placenta by carefully peeling it off from the uterus with my index-finger ; but to no avail, and was at last obliged, very reluctantly, to remove the greater portion, and to leave some little masses, which were so firmly adherent as to render it impossible to remove them without injury to the uterus itself, still attached. The placentae being separated, a contraction came on after the administration of a stimulant, which expelled my hand and the uterine contents. My patient was now in a distressing state, consequent upon the large sanguineous loss. Transfusion suggested itself; but being unable to leave, I gave stimulants and restoratives most liberally, and was rewarded in a few hours by observing a more i fa,von1'>!.hlA a.nd a.tisfactnrv condition. I The funis of the foetus first expelled measured eleven inches and a half; that of the second, twelve inches and a quarter; and that of the third, fourteen inches. Two of the children (those first born) died on the second, and the third on the third, day after delivery. The after-treatment consisted in the constant use of a bandage ; in attending to the state of the uterus and vagina during
doi:10.1016/s0140-6736(02)62539-5 fatcat:ofwdnd57vfgxpbudpgfmppxtuq