THE INFLUENCE OF SUSPENSIO UTERI ON PREGNANCY AND LABOUR

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next morning in regular order, each individual carry-ing in his hand a lighted taper, while at the head of

the column there was a catafalque with a coffin con-

taining the effigy. On either side robed students bearingextra-large candles marched as pall-bearers, and scatteredalong the line was a plentiful display of banners decoratedwith asses’ heads and other uncomplimentary allusions toBrazil’s calumniator. So realistic was the whole scene that

prayers for the dead were chanted while the procession wasen roitte, and when the final act of cremation took place inSan Francisco-square it was accompanied by the solemnstrains of De Profundis.’ " By a later account we learnthat Dr. Fort " was able to embark on the La Plata safe and

sound," and also convinced, we should think, that Brazilianmedical students have still some zeal left. ,

STATISTICAL NOTES FROM PARIS.

IN March 1891 the population of Paris was 2,424,705.According to the census taken last March it had risen to

2,511,955, being an increase of 87,250, or about 3’6 per cent.The strength of the "medical army " is said by M. Lucipiato be as follows. Medical men 2272 ; otJicie’l’s de sante 80 ;midwives 1150; dentists 125 ; apothecaries 987. There is

consequently no lack of medical aid, but its distribution inthe various quarters is very uneven. In the 20th arrondisse-ment, for instance, there are only 29 practitioners, whereasin the 8th, which is the richest in Paris but one of the leastpopulous, there are no fewer than 411 of the superior grade,and 5 of the lower. As for the midwives, they aboundwherever the population is dense and poor. One arrondisse-

ment, the 9th, possesses 33 dentists, but the 13th and 19th,are entirely destitute in this respect.

THE INFLUENCE OF SUSPENSIO UTERI ONPREGNANCY AND LABOUR.

THERE is an important and interesting paper on this

subject in the August number of the Ámerican Journal ofObstetrics by Dr. Charles P. Noble of Philadelphia. He

relates two cases in his own practice in which suspensiouteri had been performed and the uterus firmly fixed to theanterior abdominal wall by buried silkworm-gut sutures, inwhich pregnancy subsequently occurred. In Case 1 when

labour came on the pains continued for several hours withouteffect. On examination a tumour was felt resembling auterine fibroid resting above the symphysis and causing aserious obstruction at the pelvic inlet. The buried silkworm-

gut sutures used at the ventro-fixation could be distinctlyfelt through the abdominal wall at the upper margin of themass. No presentation was felt through the cervix. A

more thorough examination was then made under an

anaesthetic. It was found that the posterior wall of theuterus was extremely thin, so that fsecal masses in theintestines could be felt by the hand in the uterus. Almostthe whole cavity in which the child lay was bounded by theposterior uterine wall. The breech lay just above the upper

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limit of the obstructing mass and the child’s head was highup on the left ; the feet and legs lay to the front. Cephalicversion was performed, and delivery was effected by a veryhigh application of Tarnier’s forceps. The umbilical cordhad been compressed between the mass of muscle above

the symphysis and the child’s head, and the childwas stillborn. The mother made a good recovery. In

Case 2 the membranes were ruptured at the beginningof labour. The cervix uteri could not be felt at all

on ordinary vaginal examination, and, indeed, the

anterior lip could only be reached when the half

hand was introduced into the vagina. Under an ances-

thetic it was found that tre os was very high up andopposite the sacral promontory; it was undilated, but

dilatable. A large tumour, which was evidently the hyper-trophied fundus and anterior abdominal wall held down bythe sutures used at the ventro-fixation, obstructed the inletof the pelvis. The breech rested on the mass in question. Itwas found impossible to get the feet down, although severalefforts were made to do so, and delivery was accordinglyeffected by Porro’s operation. The patient died on theseventh day afterwards from septicaemia. Dr. Noble hascollected 808 American cases of ventro-fixation in which atleast one ovary was left. Among these there have been fifty-six pregnancies. Six ended in abortion, and seven were notdelivered at the time of writing. Among the remaining 43cases in which labour occurred at or near term therewere three deaths ; one was after the Porro’s operationmentioned above, one was from heart disease, and the thirdwas from septicaemia, the sepsis being due to a deadfoetus. Dr. Noble considers that in two of these cases the

operation for suspensio uteri had nothing to do with thefatal result, and that the mortality traceable to it is

consequently about 2 per cent. The statistics referred to

appear to Dr. Noble to show (1) that women subjected toventro-fixation are less likely to become pregnant thanother women; (2) that pregnancy and labour are gene-rally uncomplicated ; (3) that inertia uteri is not infre-

quently met with ; and (4) that serious or insuperableobstruction to labour may be produced if the fundus andanterior wall of the uterus are fixed below the point wherethe uterus has been attached to the abdominal wallat the ventro-fixation. It is probable that this serious

complication may be avoided by modifying the techniqueemployed at the operation for suspending the uterus,and especially by passing the sutures through the

anterior aspect of the fundus, and by not passing themtoo deeply into the uterine wall. It would seem advan-

tageous also that, as regards the abdominal wall, the suturesfor fixing the uterus should only include the peritoneum.It appears to be clear that the after-effects of vaginalfixation in relation to subsequent pregnancy and labourare much more serious than in cases where the uterus is

attached to the anterior abdominal wall. In the paper herereferred to it is stated that in cases where pregnancyfullows vaginal fixation abortion has occurred in 25 percent. of the cases, and that in the remainder difficulties ofthe gravest kind have been frequently met with.

THE FUTURE WATER-SUPPLY OF LONDON.

IN a paper contributed to the proceedings of the Inter-

national Congress of Hygiene in 1891 Dr. E. F. Willoughbypointed out that as regards London there were within com-paratively easy distances sources of water, the volume ofwhich was far greater than was generally supposed andwhich was at present absolutely running to waste. Tothese he wished to turn the attention of engineers ratherthan to the redundant rainfall of the Welsh or Cumbrian

Mountains, though they were the proper resource of the

great towns of the west and north. He maintained, as

several eminent engineers have held, that the greaterpart of the water yielded by sinkings in the SouthDowns was derived, not from the local rainfall, but fromthat of the valley of the Weald, where, owing to theimpervious nature of the clay soil, the surface and stormwaters, instead of being absorbed, found their way beneaththe chalk on either side. Northwards this supply was

added to that beneath the London basin, but southwards itran out at the base of the cliffs or through the sandy fore-shores into the sea. The rivers of Sussex were not of anymagnitude, while along the whole coast of Kent, from RyeHarbour to the Medway, there was but one. On geologicaland hydrological grounds a like waste of subterraneanwaters must there take place, and it was probably onlynecessary to strike the fissures and crevices in the chalk