Ruptureof the womb arises from various causes, but most usually from powerful contractions when the pelvis is small, or the fœtus large, or when it presents unfavorably. It not unfrequently results also from force being used, particularly withinstruments. In fact there is no doubt but thatnumerousfemales die from this accident, brought on by the violence, haste, and want of skill of their attendants. Few injuries are more serious, or more beyond the reach of any remedy than this, though it is sometimes suffered with impunity.
The symptoms of rupture of the womb are strongly marked, and fearfully evident. When it occurs, which is most usually during a powerful contraction, the female shrieks, and instantly complains of an agonizing pain over the seat of the rupture; her face grows deadly pale, her pulse falls, and she faints. In generaldeathis almost instantaneous, though sometimes life may be preserved for an hour or two, but very seldom. There have even been cases of recovery, but they are very few, and regarded almost as miracles.
In most cases, directly the rupture happens the fœtus escapes through the rent into the abdomen, and most of the fluid with it; but sometimes it still remains in the womb, and then if the liquor amnii is discharged there may little or nothing pass through the opening, and the danger will be much lessenedin consequence. In all cases the only proceeding which offers any chance of recovery is,to deliver as soon as possible, because when the fœtus is expelled the uterus begins to contract, so as to close the wound, and when that is effected, if but little fluid has passed into the cavity of the abdomen, all may yet go well. It may frequently happen, when the hand is passed into the womb, to turn and deliver, that nothing can be found, the fœtus having passed through the opening into the abdominal cavity, in which case the hand must be passed through the opening also, and the fœtus be brought back if possible. If however the rent is too much closed, or the child cannot be reached, theCesareanoperation is the only resort.
M. P. Dubois tells us of a case of this kind which occurred in his own practice. The female had only been in labor about an hour when she uttered a piercing cry, and sank as if suddenly mortally wounded. The head of the child, which was previously at the mouth of the womb, could not be felt, and on introducing his hand M. Dubois found its feet were passed through the opening into the mother's abdomen; he brought them back however, and effected delivery by turning with comparative ease. Strange to say this woman was dischargedcured, in fifteen days after, though the uterus was so torn that the intestines had forced themselves through the opening into its cavity, and M. D. put them back with his hand, which also passed clear into the peritoneal cavity. In all cases, after the delivery is effected, the womb should be again explored, so that if any parts have come through they may be returned before the opening closes, which it may do very soon.
Cases are even mentioned where the child passed clear out of the womb into the abdominal cavity, andremained there till absorbed, or escaped through a fistulous opening many years after; while the wound healed up, and otherwise the patient perfectly recovered. Recovery however, in any way, is a rare occurrence.
Some females seem more disposed to this accident than others; possibly from a peculiar tenderness in the substance of the womb. All are however liable to it, and this liability should beget a proper caution in all manipulations, and forbid uncalled for violence in any way.
Rupture of the vagina is much less serious than rupture of the womb, unless it occurs at the upper part, when it may give rise to similar symptoms and results. At the lower part the danger is much less, though still sufficient to excite apprehension.
The treatment is the same as in the former case. Delivery must be effected as soon as possible, and the patient kept still and cool to avoid inflammation.
It is generally thought that the greater part of these accidents result from improper treatment, and particularly from using instruments.
SECTION VIII.OPERATIONS WITH THE HAND AND WITH INSTRUMENTS.
OPERATIONS WITH THE HAND AND WITH INSTRUMENTS.