Memoir on the spontaneous expulsion and artificial extraction of the placenta before the child in placental presentations / by James Y. Simpson.

James Young Simpson

Date:: [1846?]

Credit: Memoir on the spontaneous expulsion and artificial extraction of the placenta before the child in placental presentations / by James Y. Simpson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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$in the other, the circulation through the divided vessels is stop- ped, and their tendency to bleed is arrested as soon as the phjsio- lopical conditions which called these vessels into existence and ac- tion, is completely arrested or superseded, and that though some anatmnical conditions of its vessels, apparently favourable to hemor- rhage—particularly the presence of a large venous tube or tubes un- provided with valves, and admitting of regurgitation—may be still found persisting. Ahsence of Hemorrliacje in Twin Labours, with one or loth Placentce entirely detached before the birth of the Second Child. There is another series of cases which, if my present space per- mitted, might be adduced at length, both in corroboration of the fact, that the complete separation of the placenta is not followed by hemorrhage, and in evidence of the special explanation of the cessation of the flooding which I have aboye offered. I here advert to cases of twins, in which it occasionally occurs, that, after the birth of the first child, and before the birth of the second, one or both of the remaining placentre are expelled, and yet no hemorrhage follows. Such cases may be arranged under three divisions,— namely:— 1. Twins, in which, after the birth of the first child, its own pla- centa is expelled or removed, the other infant and placenta remaining without flooding, for a greater or less length of time in utero.— When a woman (says ^lauriceau) has a plurality of children, we must not deliver the placenta till after the birth of the last infant; because there would be produced a great discharge of blood {une grande perte de sang) if we thus detached the placenta prematurely.' Dr. Denman adverts to this subject in language implying similar theo- retical doubts upon the point, and yet, at the same time, affording practical confutation of it. When (he remarks, in his observa- tions upon twins) the placenta? are separate, that of the first child as a general rule, to place a ligature upon the fcetal extremity of the cut umbilical cord, the tendency to bleed directly through its arteries, or indirectly by regurgitation through its vein, being so slight as not to require it, if the cord be not cut till the child has cried loudlv, and the lungs are in full and free action. See, in support of this opinion and practice, Dehmel in Halier's Dissertationcs Anatomicie, torn, v. p. G07; Kaltsc/imid Do intermissa Funiculi Unibilicalis Deligatione non absolute lethali. Jena, 1751; Schweik- harfl, De non necessaria Funiculi Unibilicalis Deligatione, Argent. 176.0; Carboue, Jour- nal General de Medechie, torn. iii. p. ;3.'34; Van der Ecm, De Artis Obstetriciio Hodier- norum prae Veteruni Prnestantia, in Schlegel's Sylloge Operum ISIinorum in Arte Ob- stetrica, tom. i. p. 94; Z/mn«wH, Die naturgemasse Gcburt dcs Menschen, &c., Ber- lin, 1817. C. Martin, in a Thesis published some years ago at Munich, De Ligatura Funiculi Unibilicalis, maintains that the practice of tying the fcetal extremity of the cord is not only useless, but hurtful, and denounces its adoption as a repi-ehensible crime propagated down to our times, (facinus damnanJum, ad nostra usque tempora prn- payatum,; p. 11. Whatever, observes Velpeau, may be the explanation, it always liappens, that if it is left to itself and without ligature, the cord would very rarely ex- ]>ose the foetus to any hemorrhage, or to any accident, even if it were clean cut, and not bruised or torn. fTraite dcs Accouchrmcvs, tom. ii. p. od'fi.) J Aphorismes touchant la Gossessc, itc, No. 214.$