STORY OF ROUND WORMS

Nina came to our hospital in June1960; I was a bit more experienced as a doctor. It had been just over a year since I graduated. She complained of a lump on the lower left side of her abdomen, with frequent abdominal pain. She was a young girl of about 20 years of age and not married. She was nonvegetarian. She looked under nourished. She had not had a menstrual period for six months her blood count showed, what we call mild eisinophilia, we did not pay much attention to this , although Ascaris can cause an eisinophilic pneumonitis. This can happen even without Ascaris her ESR was raised. Surprisingly the stool examination did not show any Ascaris ova this means that she had an infection somewhere.  Genital Tuberculosis was fairly common in India in those days. This can cause pelvic mass and absent periods. We had very basic x-ray services and ultrasound was unknown in the sixties. A clinical diagnosis of pelvic tuberculosis was entertained. She was given Anti tubercular treatment for three months but nothing changed. It was decided to do a laparatomy: guess what we found. A lump made of 16 Ascaris worms totally sealed by the peritoneum, arising from the fallopian tubes. There were sixteen worms in all. They were all removed. No holes could be seen in the bowel. The abdominal cavity was cleaned and closed. Nina made an uneventful recovery. She was subsequently given more treatment to clean her bowel of any Ascaris. It was also explained to her about personal hygiene and the meat she consumed. The cause of her not having a period was probably due to her poor nutrition. Her chest x-ray was clear 

Ascaris is one of the most common worm infections in the world. About one billion people suffer from it. It is a big fat round worm,

which can grow up to 35 cmin length. It can go round different parts of the body via the blood stream. Initially it can cause eisinophilia in the blood which we ignored, as there were no Ascaris ova in the stool.  In gynaecological literature many cases of Ascaris in the fallopian tubes have been described, and the first one was in 1926. 

TRIPLET PREGNANCY

It was November 1962; it was the second day of my new job at Benares Hindu University where; the government had just opened a new medical school. I and another doctor, from the same medical school were appointed as lecturers in obstetrics and gynaecology, after getting our masters of surgery qualifications in Obstetrics and gynaecology and under the supervision of a professor of surgery.

It was up to us to establish the department, attend to the paper work, and do whatever else was required. It was my second day in my new job. There was a registrar on duty in the department and she called me at about 5 am to come to the hospital urgently. An ambulance was sent to pick me up, which was the general rule because this way we were assured, that we would arrive very quickly. When I arrived in the labour ward, there was this woman Sitara Devi aged thirty-four in very strong labour, shouting and howling. This was her seventh pregnancy. She had six other children, all girls at home between the ages of twelve and two. She had never had any problems with any of her other pregnancies. They lived in a nearby village, her husband was a rickshaw driver, and they had decided to have a tubal ligation hoping that this baby surely would be a boy. She had never seen a doctor or a doula during this pregnancy. When I saw her she looked weak and emaciated what else could I expect. Her blood pressure was on the low side, she had an enormous belly. There was no time to measure it, we started her on an iv infusion in case she bled. In this hospital there was an x-ray department, but it was so early in the morning and there was no time for all this. I was sure that this was at least a twin Pregnancy with too much fluid; I was hoping that the babies were not abnormal. Within the next five minutes she delivered her first baby. This was a female weighing 4.6lbs. I was starting to wonder if there were three babies. I had never seen a triplet pregnancy the incidence of triplets is quoted as I in 60 000 or 1 in 200 million. They are now commoner with assisted technology. In the next ten minutes she delivered her second baby this was also a girl. I gave her an injection called syntocinon so that she will not bleed even though I was suspecting a third baby. It was very silly of me. This baby was lying with feet first which meant it was going to be a breach birth so I had to do a breech extraction. The baby came out in good condition; it was also a little girl. These babies were identical.  I felt very sad for the couple as they had wanted a boy but now had nine girls. l left the labour ward telling my registrar to deal with them Sitara did very well. She went home after 4 days with 3 new healthy girls. They did not have a tubal ligation hoping for a son in the future. Nearly 55 years down the track I still wonder about these girls. At medical school I had another Asha in my class who had 8 sisters. They came from a good family, they all became doctors. I wonder if any of these sisters made something of their lives. 

INJURY TO THE VAGINAL VAULT AFTER DELIVERY (CHILD BIRTH)

Pyarai aged 22 was discharged home on the third day after a normal child birth. This was her third child. She was sent home with her mother. She was explained about contraception. According to the latest Indian rules we were happy to do a tubal ligation as this was her third child. Her age did not matter. She did not want this, we advised her to return in 6 weeks so that we could fit an intra uterine loop, that is what we used in those days, it was 1959. However to my disgust she was brought over by her alcoholic husband to the hospital at about 2.00 AM, with a loop of bowel hanging between her legs. I was horrified; I did not know what to say or do. Obviously he came home dead drunk and forcibly raped her, the soft vaginal wall tore and a loop of bowel came down, for a change this was an easy case. I first started an intravenous drip, put her head down, and examined the bowel made sure it was not damaged. I replaced it very gently, gave her antibiotics and repaired the torn vagina. We kept her in hospital for 5 days, seeing her husband’s behavior; my boss put an intrauterine device in for her before she went home. This was not   a routine, but we had to do it for her. These days we keep talking about cruelty at home, I have been seeing this as an obstetrician, particularly in countries like India for last 60 years. Nothing has changed, cruelty towards women continues. I so much wish that organizations, like The Melinda and Bills Gates charities, governments, Millennium Development program's, prevention of domestic violence can help these women with education equality and empowerment. Happy families make happy societies’, happy nations and in the end a happy world.