In reference to the fibroma, with which Professor Ludlam has kindly given us his interesting case, I will state here, as he did not, that one of the five Caesarian sections was for a fibroma, in which the child had been been dead three days, and in which the mother had been in labor some thirty-six or forty hours, and it was thought that it was possible to deliver her; but they could not do so on account of the fibrous condition of the os, it being crowded way up behind the symphysis pubis, so that we could not reach it, and we performed the operation; that the weight of the tumor and uterus was eleven and a half pounds, and the weight of the child was ten pounds; and the woman went ten days before death, and death occurred from haemorrhage of the womb.
We had to use clamps. The ligature-clamps had not been introduced by Keith, and even if Keith’s clamps had been in use at the hospital, she was at her home when the haemorrhage began, and the sent for her physician, but the could not get there in time.
I may state, in conclusion, that Akron, Ohio, has afforded two of these cases. It nearly afforded a third case; if I had received the telegram in time to catch the train the woman might possibly have been saved; but I got there six hours after on the next train, and when I was going to the house, which was three miles out of Akron, and some little distance from the road-for they were poor German people-the two doctors came to me in a carriage, and told me about the case, and said that we would have to perform Caesarian section on account of some obstruction. As I stated in the paper, the conjugate diameter is not the test whether you shall operate or not.
There are other conditions existing, which you must look to. When we were leisurely walking up to the house, expecting to perform the Caesarian section, the husband came out and told us to hasten, and when we got to the door we heard the cry of the child. The child was born. The midwife had turned the woman in a different position, or rather put her in a knee-elbow position, which enabled the child to be born.
This was case of uterine-fibroma, the size of a coconut, situated at the junction of the cervix with the body, and the Doctors could not, under any circumstances, get inside of the womb (so they said); but by the change of position the woman was able to deliver-but at the cost of her life. She died from septicaemia, some seven or eight days afterwards. I think by Pean’s operation, or Caesarian section, if we had been able to reach there six hours earlier, we would have saved the mother.
