The accidental hysterectomy

Forcible removal of the uterusIn 1840 one Dr Drane, a physician from Louisville in Kentucky, wrote a short communication to the Western Journal of Medicine and Surgery. The editor was astonished, commenting that the case was “unique in the annals of obstetric medicine”. It’s certainly, ahem, special:

A woman residing in Oldham county, in this State, was attended by a midwife in her fourth or fifth confinement. Shortly after the birth of the child, the midwife applied herself to the task of removing the placenta, and seizing hold of the os tincae, which was taken for the placenta…

‘Os tincae’ is an archaic term for the opening of the uterus into the vagina. ‘Tinca’ is the Latin for the species of fish known to us as a tench; as the eighteenth-century surgeon William Northcote explains: ‘its orifice into the vagina is called os uteri, and by some os tincae, from the resemblance it bears to a tench’s mouth; it may be also compared to the mouth of a young puppy dog.’

The placenta is often expelled from the womb shortly after the birth of a child, but it is sometimes necessary to remove it manually. This would normally have been a routine operation for an experienced midwife, but alas this was no ordinary case. The object she assumed to be the placenta and grabbed was, in fact, part of the womb:

…she applied such extractive force as to lacerate the vaginal and ligamentous attachments of the uterus, and bring away the entire organ with the remnants of its ligaments, the Fallopian tubes and ovaria.

A frightful accident. Instead of removing the afterbirth she had instead performed a crude hysterectomy. Surprisingly, this was not followed by terrible bleeding.

Very little hemorrhage followed this rude operation, but the patient being alarmingly prostrated by the violence she had suffered, Dr. Ballard, of Westport, was summoned to her assistance. When the Dr. arrived and inquired concerning the delivery, he was informed by the midwife that the patient was cleared, and his attention was directed to a vessel containing the supposed after-birth, as evidence that she had performed her whole duty. He was surprised and alarmed for the safety of his patient to find on examination that it was the uterus and its appendages, which were deposited in the vessel, and on making a section of the uterus, the placenta was found enclosed in its cavity.

Well yes, I imagine he would be a little ‘surprised and alarmed’.

Dr. Drane did not see the patient nor is he informed as to the history of the case after the accident; he only knows that, without any very serious consequences, the woman recovered perfectly; that she is at this time alive and in good health, and has borne no children since her mutilation. He had more than one opportunity of examining the parts, preserved by Dr. Ballard and, perhaps, still in his possession, and he assures us unequivocally that they comprise the uterus, containing the placenta, the tubes, ovaria, and portions of the uterine ligaments.

It would be easy to vilify the midwife for this incident,  but the article notably refrains from doing so. The patient almost certainly suffered an inverted uterus, a rare and potentially serious complication of childbirth in which the uterus protrudes into the vagina. It’s quite plausible that the midwife had never heard of, let alone seen, such a thing, so her error is I think understandable.

A couple of months later the Western Journal published a follow-up from the physician who had actually attended the unlucky woman, a Dr Ballard.

Ballard's case of extirpated uterusHe explained the events in the original article had taken place some twelve years earlier, in 1828, and that he had lost his original notes of the case. But he did recall that the woman was 32 and ‘very corpulent’. In the immediate aftermath of childbirth and the unintended hysterectomy she suffered somewhat from flatulence, but recovered in a couple of weeks. Her diet for most of this time was nothing but rice water, which does not sound terribly nutritious for a woman who had just given birth. Dr Ballard also confirms that ‘she has enjoyed perfect health ever since’. He concludes his article thus:

Another interesting physiological fact.—Inquiries instituted two years after the recovery of my patient convinced me, that the accident had not entirely deprived her of sexual propensities: yet both the ovaria were removed with the uterus.

Fancy!

Uterus
The uterus and vagina, from the Atlas of Anatomy by Jean Baptiste Marc Bourgery and Nicolas Henri Jacob, published between 1830 and 1854.

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