An address on some of the relations of pregnancy to surgery : delivered at the first meeting of the Mirfield and District Medico-Chirurgical Society / by Mayo Robson.

  • Robson, Arthur William Mayo, Sir, 1853-1933.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: An address on some of the relations of pregnancy to surgery : delivered at the first meeting of the Mirfield and District Medico-Chirurgical Society / by Mayo Robson. 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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    respectively, and diagnosed as such by their medical attendants, both men of experience and skill. Curiously, both brought forth prematurely tlie day after admission, the uterine tumour being a case of liydramnios, with twins, the ovarian being an ordinary case of pregnancy. The latter case was simply an oversight on the part of my medical friend, who accepted the patient's statement that pregnancy was impos- sible, and relied on an examination through the clothing. The former liydramnios was more difficult of diagnosis, and, as the twins were dead and quite small, the only certain sign to be obtained was ballottement; as a matter of fact, the diagnosis of liydramnios was arrived at before the uterus ex- pelled its contents. I have seen two other cases of hydi-amnios to create a diffi- culty in diagnosis ; in one an operating surgeon asked my opinion on a case he was going to operate on within the week. The abdomen was an enormous size, but the feeling of solid through fluid made me suspicious, and I suggested the use of the exploring syringe, which drew oS liquor amnii and cleared up the diagnosis of the case. In the other, an eminent surgeon whom 1 knew actually perfoi'med hyster- ectomy, and only after removal it was found that the uterus contained shrivelled twins. From these, and many other cases that I could relate, I always feel it my first duty in making a diagnosis of abdomi- nal tumour to eliminate pregnancy. At times, in the early stages, this may be difficult without the passage of the sound, which would, of course, bring on abortion, and which would be unjustifiable ; but such cases will, as a rule, wait if necessary until the period of quickening is reached, when the foetal heart can be heard. The bimanual examination with or without an ansesthetic in the case of pelvic tumours, and the stethoscope and other signs when the tumour has become abdominal, will usually overcome all difficulties; at all events, in a tolerably large experience these precautions have so far kept me from real difficulty, and I have not yet had the mortification of opening a pregnant abdomen unintention- ally. (c) Ectopic Pkegnancy. This subject is one of no less scientific interest than prac- tical importance, for not only does it offer several problems difficult to explain, but from its frequent occurrence, its alarming and dangerous symptoms, and its curability if treated scientifically, its study becomes of the first interest to the general medical practitioner as well as to the operating surgeon. It is a curious fact that in eveiy female mammal above the monotremata there is a section of the genital canal be- tween each abdominal ostium and the uterus, in which under normal conditions the impregnated ovum is not retained, and that, so far as is at present known, the lodgment and growth of an impregnated ovum has only occurred in this situation in woman, when the disease is known as tubal pregnancy or extrauterine fcetation, or ectopic gestation. Perhaps it is that woman only sufl'ers from desquamative salpingitis, which Mr. Lawson Tait says is always present in such eases, though in one of my cases there was apparently no evidence of this. Tubal gestation is of interest also from the many accidents that may occur in its course. The position of the ovum in the tube and the site of the placenta predisposmg to tlie special form which thf case will take.