The induction of premature labor and accouchement forcé in the first 5000 labors in the Obstetrical Department of the Johns Hopkins Hospital / by J. Whitridge Williams.

  • Williams, J. Whitridge (John Whitridge), 1866-1931.
Date:
[1906]
Catalogue details

Licence: In copyright

Credit: The induction of premature labor and accouchement forcé in the first 5000 labors in the Obstetrical Department of the Johns Hopkins Hospital / by J. Whitridge Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    22, 24.5, 28, 17.5 and 11.75 cm. The cervix was very hard and almost cartilaginous in consistency, while the external os would not admit the tip of the little finger. Dilatation was begun with Goodell’s instrument and after an hour’s efforts its canal would admit only the little finger, so that it was out of the question to attempt Harris’ method. Accordingly, a small Champetier de Ribes balloon was introduced, and, upon withdrawing it twenty four hours later, the cervix was found to be considerably softened but only sufficiently dilated to admit the index finger without diffi- culty. Further dilatation was effected by means of Hegar’s graduated bougies and finally by Harris’ method. At least one hour was required to bring about sufficient dilata- tion to permit version and extraction of the tlead fetus. The cervix was deeply torn, but as it did not gitfe rise to hemorrhage it was not repaired. Death occurred eleven days later from infection, which the autopsy showed was clearly attributable to the prolonged manipulation and injury to the cervix. These two deaths do not exhaust the untoward effects of manual dilatation under such circumstances, as one finds that the cervix was uninjured in only three cases, while it was slightly or deeply torn in three and seven cases, re- spectively. 1 hree of the latter gave rise to profuse hem- orrhage and required immediate repair. (b) Harris’ method was employed in seven cases in which the cervical canal was obliterated but the external os not dilated. In this group of cases manual dilatation was usually effected without great difficulty. One patient died in coma while the other six recovered. Even under such circumstances the operation cannot be said to be abso- lutely devoid of danger, as the cervix was uninjured in only two instances while it was deeply torn in five cases, two of which required immediate repair on account of profuse hemorrhage. (c) In eleven cases the cervical canal was obliterated and