Abdominal and uterine tolerance in pregnant women : as shown by the low rate of mortality under severe lacerated and other wounds, the result of direct violence / by Robert P. Harris.

  • Harris, Robert P. (Robert Patterson), 1822-1899.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Abdominal and uterine tolerance in pregnant women : as shown by the low rate of mortality under severe lacerated and other wounds, the result of direct violence / by Robert P. Harris. 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.

    7/20 (page 7)
    ture. This rule also applies in the cases of abdominal rip in pregnant women, and for two reasons—viz., the horn seldom comes in contact with an intestine where the woman is far advanced in pregnancy; and where she is in the early months, it will rarely perforate or tear the slippery outer coat of the yielding, movable bowel. In some cases on record, the intestines have no doubt been wounded, as the symptoms and early death of the women would appear to indicate. AVhere there is no such complication, the teachings of history would lead us to give a favorable prognosis, although our fears might induce us to look on the dark side. The lacerations are usually in an oblique direction ; some- times they are transverse; but it is very rare to find them in the direc- tion of the linea alba. For the same reason that the intestines are rarely torn, we may find a mural laceration, even of several inches in length, which has not opened the peritoneal cavity, the peritoneum preserving its integrity and the small intestine showing through it. In another case, we may find that the horn has cut a long furrow, and has then made a pene- trating rip of a few inches, with eventration of omentum and intestines. About twenty years ago, Mrs. Capron, of Chicago, then a missionary in India, was called to see the wife of a Brahmin lawyer, at the time five months pregnant, who had received a horn-rip from a driving- buffalo, such as are used in the place of horses in that country. The wound was directly beneath the umbilicus, and about six inches in length, the gash extending down to the peritoneum, but not through it. Strips of adhesive plaster sufficed to keep the wound closed, and to secure primary union without suppuration; the woman carried her foetus to maturity, and she and her boy were alive long afterward. Contused horn-wounds of the abdomen, without laceration of surface, may be much more serious in their effects than where the parts have been torn through ; and this is particularly the case where the placenta is attached to the anterior section of the uterine wall, and is beneath the point struck by the horn. In such a casualty the placenta may be centrally detached, the woman brought to bed with a dead foetus, and her life endangered by hemorrhage from the placental site.1 Horn perforations of the abdomen, or the abdomen and uterus, with- out extension by subsequent laceration, are very rare, for in such a casualty the animal is usually passive, and the woman is thrown upon his horn, as in the case of the production of a stake-wound. Even a horn-perforation may give exit to the hand of the foetus, and require that labor should be induced as in Case 8 of table. An interesting case of perforation by a wooden pitchfork was re- ported in the Journal de Chirurgie, of Malgaigne, for December, 1846, by Dr. C. Czajenski, the subject being a healthy woman, twenty-seven 1 See the Cummins case, in Dublin Quarterly Journal, 1858, xxxv. pp. 228-231.