CENTRAL LACERATION OF THE PERINEUM

DURING LABOR.

BY P. R. CORTELYOU, MARIETTA, GA.

In reporting this case to the Association, I am led to do so, not because of any new method of treatment to recommend or any brilliant result to record, but merely from the extreme rarity of such an accident, never having seen a similar one reported; and upon investigation, as far as I have been able, not finding anything in regard to this class of cases, except being mentioned in some of the works on obstetrics as a very rare possibility.

About seven o'clock on the morning of November 11, 1896, I was called in consultation with Dr. E. J. Setze, but on my arrival at the house labor had terminated.

The doctor gave me the following history of the case. He had been called the night previous, and found the patient, Mrs. G., a primipara, aged about twenty-six years, in the first stage of labor. She had been in her usual health during the whole period from the time conception had taken place. As he lived near the patient, he returned home, directing the nurse to have him called as soon as the pains became strong and continued. About 2 a.m. he was summoned, and found labor progressing nicely, the cervix being well dilated and the vertex presenting. The pains continued regular and strong, and all went satisfactorily until the head pressed on the floor of the perineum, and then, although the pains were good and strong, the perineum did not relax, but with each pain became more and more tense,

the head making no advance. Thinking it might be necessary to do episiotomy, I had been called.

During a very hard pain the head had passed into the world, making a lateral tear through the perineum, about · one and a half inches below the fourchette and anterior to the rectum. The child and placenta passed through the wound, which we found on examination to be between four and five inches in length and with rough ragged edges.

The doctor said that, using all his strength to keep back the head and raise it up, he had been unable to prevent the accident.

Upon further consultation it was deemed best to call extra counsel, and Dr. Virgil Hardon, of Atlanta, came up in the afternoon. The patient was then put under the influence of chloroform, and after thorough cleansing and with full antiseptic preparation, Dr. Hardon closed the wound, using twenty-two sutures. The operation lasted one hour and a half.

The patient's condition at the close was very good, and at 7 o'clock pulse was 80, temperature 99 3-5; but being restless was given grain of morphine hypodermically. The urine was taken with catheter; beef tea and broths ordered. November 12, 8 a.m. Temperature 101 degrees, pulse Complained of pain grain of morphine

96; 5:30 p.m., temperature 102 3-5. and cramp in left leg, and was given hypodermically.

November 13. Nurse reported quite a free sweat at 2 a.m. Temperature ranged during the day from 101 to 103 2-5. Injections of bichloride solution used freely, also iodoform locally. Urine still taken with catheter. Castoroil one-half ounce given, which caused frequent actions. during the day and night.

November 14. Temperature 101 4-5 to 102 3-5 during the day. Dover's powder and bismuth were given to check too free action of bowels. Some of the stitches ulcerating.

Breasts were emptied and bound. Complained of cramp in the legs during the day.

November 15. Many of the stitches were removed, as they had cut out, and the lochial discharge passed through the opening. The antiseptic douches and iodoform were used faithfully, and every effort made to keep the parts clean.

November 16. Remaining stitches removed, as they were doing no good. Quinine given freely, tonic, milk and beef essence. Urine still taken with the catheter. Temperature 101 1-5 to 103 1-5. Involuntary passages from the bowels.

November 17. Condition unchanged and continued same with gradual failure of vital forces until December 19, when death occurred.

During the whole course of treatment every effort was made to prevent septic infection, but without success. A very intelligent and thoroughly trained nurse was in charge from the first till the case terminated. The wound generally had a healthy appearance, although there was considerable sloughing and only a thin band of tissue was left between the lower margin of the vulva and the wound.

CONSTITUTION AND BY-LAWS

OF THE

Medical Association of Georgia..

CONSTITUTION.

(ADOPTED 1873.)

ARTICLE I.

NAME.

The name and style of this Association shall be "TheMedical Association of Georgia."

ARTICLE II.

OBJECTS.

Section 1. The object of this Association shall be to organize the medical profession of the State in the most efficient manner possible; to encourage a high standard of professional qualifications and ethics, and to promote professional brotherhood.

ARTICLE III.

MEMBERS.

Section 1. There shall be only one class of members in this Association. Any regularly educated white physician, who resides within the limits of this State, who is a graduate of a regular Medical College in good standing, and who adopts and conforms to the Code of Ethics of the

American Medical Association, shall be eligible to membership in this body.

ARTICLE IV.

OFFICERS.

Section 1. The officers of the Medical Association of the State of Georgia shall be as follows: 1st. One President; 2d. Two Vice-Presidents; 3d. One Secretary; 4th. One Treasurer; 5th. Five Censors.

Sec. 2. The Presidents shall be elected for one year; the Vice-Presidents for one year; the Secretary for five years, the Treasurer for five years-but every officer shall continue in office until his successor is elected and installed in office.

Sec. 3. The Board of Censors shall be elected at the present session by the Association-one for a period of five years, one for four years, one for three years, one for two years, one for one year; and annually thereafter the vacancy occurring in the Board of Censors shall be filled by election.

ARTICLE V.

PRESIDENT.

Section 1. The President shall be the chief executive officer of the Association. He shall preside at all the meetings of the body, preserve order, and give the casting vote when necessary, and perform such other duties as parliamentary usages impose on presiding officers.

Sec. 2. He shall prepare and deliver, at the opening of each annual session, an address on some subject connected with the interests and objects of this Association.

Sec. 3. He shall appoint annually the requisite number of delegates to the American Medical Association, and to such other scientific bodies as it may be expedient to have this Association represented in.