Essays In Pastoral MedicineWalsh, James J. (James Joseph)
Religion
Essays In Pastoral Medicine
Walsh, James J. (James Joseph)
First aid in illness and injury; Medicine
Medical authorities tell him to do coeliotomy at once, ligate the
uterine and ovarian arteries, and remove the foetus. Would he
certainly or probably be justified in following out this medical
doctrine?
The mother is in actual, _very probable_ danger of death, but not in
actual, _certain_ danger of death. She may possibly escape if
operation is deferred; she has a negligible chance of escape if no
operation is performed after the death of the foetus; coeliotomy and
ligation of the uterine and ovarian arteries give her by far the
surest chance of escape, so sure an opportunity for escape when
performed early that it can scarcely be called a mere chance.
If operation is deferred the chances for rupture are about 22 per
centum, say, one and a half in five chances, and all ruptures are not
necessarily fatal. The chances of the mother's death, however, are
much higher than that, because death can come in ectopic pregnancy
from causes other than rupture. From 63.1 to 68.8 per centum (say,
66.3 per centum) of ectopic gestations treated by the expectant method
result in death to the mother--just two-thirds of the women die. A.
Martin in a series of 265 cases of ectopic gestation where the
expectant treatment was employed found a maternal mortality of 63.1
per centum; Parry in 500 similar cases found a mortality of 67.2 per
centum; and Schauta in 241 cases a mortality of 68.8 per centum.
In the 87 years between 1809 and 1896, 77 cases of coeliotomy for the
delivery of _viable_ ectopic foetuses were reported {30} in all
medical literature with a maternal mortality of about 58.3 per centum.
Between 1809 and 1888 there were 37 coeliotomies with a maternal
mortality of 86.5 per centum. Between 1889 and 1896 there were 40 such
operations, with a maternal mortality reduced to 32.5 per centum by
modern surgical methods.
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