Basilysis for dystocia from hypertrophic elongation of the cervix uteri / by Alexander Russell Simpson.

  • Simpson A. R. (Alexander Russell), 1835-1916.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Basilysis for dystocia from hypertrophic elongation of the cervix uteri / by Alexander Russell Simpson. 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.

    11/16 (page 9)
    was ended by means of powerful expression frona above wliile the margin of the os externum was pushed back over the head. In a paper on Amputation of the Cervix Uteri, read by Dr A. K. Gardner before the New York Academy of Medicine,' a very graphic account is given by his friend Dr S. D. Shelton of the clifticulty he experienced in effecting the delivery of a patient in whom labour was delayed from hypertrophy of the cervix. Her last confineraent, he says, commenced at 11 a.m. Satur- day, 27th July 1861. I was not sent for until late in the after- noon, when she had been some six hours in the pains of labour. The pains had been regular, though short and little jiropulsive. I found the cervix uteri protruding from the vulva with the child's head somewhat engaged witliin it—that is, at its upper extremity. T do not mean that the head itself had as yet emerged from the vagina. I watched patiently and anxiously the slow progress of the case ; but finding, after many hours, that the pains were inefficient and having little propulsive force, I administered cautiously and timidly (at first) ergot in the form of fluid extract. This was attended with a slight degree of propulsion, and the head advanced to a certain ex- tent, but there it remained hour after hour—and how tedious and wearisome to more than the sufferer those hours!—pain after pain wearing out the strength without avail. I applied the forceps ; carefully and gently I used them—employing, at first, a retractor like those used in amputations to antagonize my efforts in traction. But the retractor proved useless, and my efforts with the forceps of very doubtful utility. Still hoping I had made some progress, which the pains would urge on still further to the end, I withdrew the instruments, and left the case again for a while to nature—being myself somewhat fatigued with the force employed, and fearing I might injure my patient by drawing down the whole uterus, having no sufficient means at hand, at that time, to antagonize my efforts at traction. A.gain I administered ergot, giving her at the same time occasionally a little gin toddy to sustain her strength. During this tedious interval I revolved in my mind, over and over, the propriety of liberating the head from its incarceration by making a long and free incision through the whole extent of the cervix—the whole obstacle to delivery consisting in the fact that the pro- pulsive efforts of the uterus forced down, not the head alone, but the head enclosed in the cervix as in a cap. Tliis I should at length have done, but I determined first to make one more effort with the forceps. I applied the instruments, and having this time the assistance of the husband, I directed him to grasp the whole cervix m the palms of his hands, standing himself with his back towards the head of the patient, and, with a firm and steady, but gentle effort of strength, to draw upwards as I drew downwards with the forceps. In this way we both laboured until almost ex- ' Bulletin nf the Neji; York Academy of Medicine, April 1862.