Notes on a Case of Spontaneous Rupture of the Uterus during Pregnancy through the Cicatrix of a Cæsarean Section Wound, with a brief reference to similar recorded cases *

TIIF, following is the history of the case which forms the subject of this communication. Mrs. M., .i-para, was admitted to the Glasgow Maternity Hospital on January 26th, 1904, with a view to having Caesarean section performed for the second tirue. Two years previously I delivered her of a living male child by Cssarean section. Here are my notes of the case on that occasion: “ Mrs. M., 3-para, was admitted on October 2Sth, 1901, t o the Qlasgow Maternity Hospital. I n both the previous labours the children were extracted with di5culty, and were tlcacl. O n the last occasion craniotomy had t o be performed. The pelvis was of the flat rachitic type, the diagonal conjugate being 32in.” There seemed to be little if any deformity in the transverse diameter. She was not in labour when admitted but it came on 12 hours afterwards. I intended t o do symphysiotomy, and so allowed labour to go on until the 0s was fully dilated; when however, that stage was reached i t was found on examining her and testing the relative sizes of the head aud the pelvis that there was too great a disproportion between them to perniit of symphysiotomy being done safely. I therefore chose Czsaxean section and employed the “ fundal incision ” of Fritsch. I came right down on the placcnt&, wliich I remoyed before extracting the child. The child, which weighed Slbs., was extracted very easily, and the uterine wound stitched with little trouble or bleeding. She was not sterilized. She had a good dcal of retching and vomiting during the first three days, but otherwise there were no unfavourable symptoms. The temperature was never above nornial, and the pulse after the first three days was not accelerated. The wound healed by first intention, the stitches being taken out on the fourteenth day. She left the Hospital on November 30th, both she and her baby being perfectly well.