Volume 2

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

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

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    unfavorable. The foetus commonly dies early in the course of the disorder, and abortion or premature labor results. Out of 57 cases collected by Lomcr, 45 foetuses were stillborn. In those cases simple icterus was just as fatal to the product of conception as the malignant form of the disorder. The cause of foetal death is due in the majority of cases, as pointed out by Davidson, to the bile acids which have been found in the fietal blood. As a rule, the skin of the foetus is not icte- roid. Out of 62 cases collected by Lomer, the foetuses were icteroid in only 6, although the liquor amnii was stained with the biliary coloring matters in all. As pointed out by Lomer, it is highly probable that this fact is due to the difficulty in passing the placenta experienc-ed by all slightly soluble substances. If the icterus is intense and has persisted for a considerable period of time, the skin and all the tissues are apt to be tinged with the bile- ])igmcnts—a c-ondition termed cirrhonosis by Lobstein.^ The causes of simjde jaundice in pregnancy are identical with those which produce the condition in the non-gravid state, and are frequently obscure. It is in a high degree probable that pressure from the gravid uterus is entirely inoperative, since the symptom may appear at any time during gestation. The morbid condition commonly present is a catarrhal inflammation of the muc*ons membrane of the common bile- duct or of the duodenum in the vicinity of the orific“e, causing a nar- rowing of its lumen. DrAGNOSiR.—The conjunctivse, skin, and urine are colored bright vellnw, and there is complete absence of febrile and cerebral symptoms. PnofixosTR.—The prognosis Avith reference to the mother must always be guarded, in view of the unfavorable influence exerted by pregnancy upon the course of the disease. In the jiresent state of our knowledge it is impossil)le to make even a general statement as to the relative fre- quency of this omirrcnce. The outl(K)k with rcferenc'e to the child is always gloomy. In the few (uses in which a living child has been born death has c-ommonly resulted within the first days of the puer- perium. Tue.\tmkxt.—Active medical treatment, in accordance Avith the AA’ell-knoAA’ii principles, is strongly indicatc<l just as soon as the icterus make its ajApcarance. Excretion by the kidneys must be stimulated, and rendered compensatoiy as nearly as possible. The induction of premature labor in the interest of the mother is seldom indicated, inas- much as the prompt institution of a rational therapy usually remoA'cs the morbid condition. When the icterus is intense and of long dura- tion, this operation is frequently indicated in the interest of the child. > In Carl Braun’s cases, already mentioned, the condition Avas probably due to byper- tropbic hei>atitis in one case, to disturbances in connection Avith the ductus choledochus in scA’enteen cases.