A manual of midwifery / by Alfred Meadows.

  • Alfred Meadows
Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: A manual of midwifery / by Alfred Meadows. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    406/476 (page 382)
    and in fhat case, of course, the life of the child would be of paramount importance. The fsubsequent management of these cases, supposing the mother dehvered, and to have recovered from the first shock of the accident, will be the same as for peritonitis— opium in moderately large doses, counter-irritation to the abdomen, alkalies, and a generally supporting plan of treatment will be the remedies chiefly required; but when it is remembered that the opening remains in the bladder, and that consequently urine will continue to be poured into the peritoneal cavity, it will readily be seen how futile must be the attempt to check the inflammatory process. Opium is the chief, perhaps the only remedy likely to be of service, with such support as may seem needful. The operation suggested by Blundell, of opening the abdomen, washing out the cavity, and stitching up the rent in the bladder, does not appear to be a very hopeful proceeding, and I do not know of any case in which it has been performed. riSTULuE. Vesico-vaginal fisfulce, unlike ordinary rupture of the bladder, are seldom due, directly at least, to over-distension of that viscus and consequent rupture, but are usually caused by long-continued pressure upon the bladder, either by the forceps or by the foetal head. Such pressure destroys the vitality of the bladder structures, and either at once produces a slough, or sets up inflammation and subsequent ulceration, by which an opening is made. The bladder may also be opened by ulceration extending from the uterus, as in cancer or corroding ulcer. When it results fi-om pressure during labour, it is found that a long-sustained pressure is more certainly mischievous than one shorter but more severe. Statistics abundantly prove this statement, and point very forcibly to the con- clusion that patients ought not to be allowed to remain imdelivered for many hours with the child's head im- movably fixed in the cavity of the pelvis, pressing upon the bladder and leading to its subsequent sloughing. The opening may be situate either at the neck or back part of the bladder, and will, of course, vary in size ac- cording to circumstances. The Siiwftoms are incontinence of urine, with a con- stant dribbling of water from the vagina. Considerable