Herbert Williamson

A Case of Inversion of the Uterus caused by a Squamouscelled Carcinoma of the Fundus.1

C. B., aged 54, married 23 years, was admitted to St. Bartholomew’s Hospital on May 14, 1923, complaining of a profuse vaginal discharge-offensive and blood-stained. Menstruation had commenced at tlie age of 14, the cycle was 28 days, the duration seven days and the flow profuse. The menopause occurred in 1921. The patient had never been pregnant. She was in her usual health until October, 1922, when she first noticed a vaginal discharge, sometimes blood-stained. This gradually increased in amount. I n March, 1923, the discharge became yellow and offensive, ‘and haemorrhage occurred two or three times weekly. About this time she commenced to suffer severe pain, felt chiefly in the sacral region ; she became anaemic and her health deteriorated rapidly ; she also developed incontinence of urine on coughing and on exertion and when lying in bed. These symptoms persisted to the time of her admission. When first seen the patient looked ill, she had a yellow sallow complexion, her tongue was furred and she was anaemic. The temperature was 1004~ F. and the pulse-rate varied between 80 and 100. Abdominal examination revealed nothing abnormal. The vagina was occupied by a sloughing irregular mass as large as a man’s fist; the tissues composing it were friable and large fragments came away on touch. The relation of the mass to the cervix uteri was not definitely determined, but tlie anterior lip could be felt high up behind the symphysis pubis and its texture was apparently normal. The examination caused such profuse haemorrhage that it was abandoned, the vagina hastily plugged and an anzesthetist sent for. On his arrival the plugging was cautiously

Death of the Child due to Rupture of Umbilical Vessels during Labour.

DEATH of the dhild during labour from hemorrhage caused by rupture of the umbilical vessels is a rare phenomenon. A normally inserted cord may be torn across when a woman is delivered in the upright position, and similar accidents due to absolute or relative shortness (when during delivery the woman was recumbent) have been observed by Westphalen and Meyer. In most instances, however, where a child has bled to death from rupture of an umbilical vessel during labour the insertion of the cord has been velamentous. I propose to record a case of this kind and to offer a few remarks upon the condition. Many errors of development of the placenta are of embryological rather than of clinical interest, but velamentous insertion of the cord is an exception, for the life of the child is placed in danger. Those who have tabulated series of cases state that the insertion of the cord is velamentous in about -7 per cent. of all human placents. Chiari found i t in -4 per cent. of all placenta examined, Lefevre in -84 per cent., Croom in 7 per cent., and Ahlfeld in -9 per cent. In twin pregnancies it is more common; in the Dresden Clinik, under V, Winkel, it was found in 5 per cent. of twin placentae, but in only *57 per cent. of single placentae, and statistics from other clinics confirm this observation. Cases of velamentous insertion of one cord with uniovular twins have heen recorded by Valenta, Kuhn, Huter, Winslew, Kiesel, Ruger and Riiclter. Thevenot has described a twin placenta in which the insertion of both cords was velamentous. I do not intend to enter upon the vexed question as to what errors of development give rise to this abnormal condition or as to why it should be particularly common with nniovular twins. Hubert Peters has critically examined the various suggestions made, and I refer those interested in the question to his paper. It is sufficient to say that some of the explanations offered are founded upon fundamentally false conceptions of the development of the umbilical cord, and that the rest are mere guesses, not theories built upon solid foundations of observed facts. The essential anatomical feature of a velamentous placenta is the termination of the cord a t some distance from the placental margin, the vessels diverging from one another and running over the chorion

A Case of Intra‐uterine Death of the Fœtus Occurring in Six Consecutive Pregnancies: with Observations upon the Importance of the Examination of the Fœtal Tissues for Spirochæta Pallida.*

A.B., aged 24, was first seen by Dr. Williamson on November Brd , 1903. She came to the Royal Waterloo Hospital because she had given birth to two still-born children, and, believing herself to be pregnant again, wished to know if anything could be done to prevent a similar mishap. Menstruation commenced at 17, and occurred regularly every twentyeight days until the time of her marriage. She w a ~ always a healthy girl, and was one of a family of five; her brothers and sisters are all married, and all have living children. She married at the age of 23, and two months later became pregnant. after 26 weeks’ gestation she was delivered of a still-born child. Six months later she again became pregnant, and again gave birth to a dead child at the end of the 28th week. Dr. Williamson saw her five months after this event. On examination he found she was three months pregnant, but could discover no abnormal condition in the pelvis, and no signs of any general disease. The question of syphilitic infection was carefully inquired into, but with an absolutely negative result. Neither she nor her husband had even followed any injurious occupation. The cause of the death of the fe tus therefore remained a mystery. She was treated with small doses of chlorate of potash, and was lost eight of for nearly two years.