The principles and practice of obstetricy, as at present taught / by James Blundell ; to which are added, notes and illustrations by Thomas Castle.

Date:
1834
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of obstetricy, as at present taught / by James Blundell ; to which are added, notes and illustrations by Thomas Castle. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    the pregnancy was extra-uterine. All these ohservations are most easily made, when the abdominal coverings aie thin. When the womb is enlarged from pregnancy, in the general you do not observe any thing like fluctuation ; therefore, if the bladder is duly evacuated, and if there is no dropsy of the peritoneum when you strike the abdomen, no fluctuation will be perceived. Understand, however, that under disease, the liquor amnii some- times collects in very large abundance, to the amount of three or four gallons for example, and, in these cases, a fluctuation may be felt distinctly, as if the woman were dropsical.* This I men- tion to you, the rather because it is not very common, and because if you were not aware of it, and chanced to meet with one of these fluctuating wombs, you might rashly have recourse to the trocar and canula. It is by your learning from the patient that she her- self believes that she is pregnant, and that the enlargement of the abdomen has very suddenly occurred, that you are first led to sus- pect the nature of the case ; for usually, where the enlargement has very suddenly occurred, it does not arise from ascites, but * In the middle months of gestation, a woman laboured under a great swellmg of the abdo- men, which fluctuated distinctly. Dr. Haighton was sent for, together w.th a very d^t.n- guished surgeon, who, conceiving the case to he ascites, proposed callmg next day L operation of tapping. Dr. Haighton suggested that this abdominal swellmg might after all be « dropsy of the uterus, but no particular examination of this point was tha’t day: in the course of the night, the membranes, which contained all this water, hurst o themselves, a flood of fluid was discharged, the abdomen rapidly collapsed, a fmtus issued tlraer ban the first joint of the finger, the woman escaped from her paracentesis, and V I ell Here then, is a case in which a surgeon of distinguished talent, in consequence oS a hasty diagnosis, was on the point of puncturing the uterus ; do you, therefore,be on your Tst the treatment of this disease, if the swelling is not very SmsTa; grvlt;,Te—'u^^ nine months; if, on the the mouth of the uterus, great care being taken not to injure the cervix. In ordinary cose I think, I should not make a large opening, for if the opening be a mere puncture the wate may come off by little and little, and the abdomen may sink the more gradually. If the irsLld come away more rapidly than you expected, then put a bandage round t c patient in the same manner that you would do if you were tapping in a prepare for syncope. Galtskell’s bandage would answer very wcll.-Di. musuleU.