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?]
Catalogue details

Licence: Public Domain Mark

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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    of 1 in every 6 or 8 subjected to it.' The occurrence of placenta pr^evia is twice as dangerous and fatal as the operation of litho- tomy,—1 in every 3 perishing under the first, and 1 in every C or 8 perishing under the last. Looking at these results, it will, we believe, be readily conceded, that any attempt—such as is the professed object^ of the present memoir—to diminish this fearful maternal mortality in placenta prsevia, is entitled, at least, to the consideration of the obstetric profession, even should it fail to be so fortunate as to secure their concurrence and conviction. , Section II.—Recognizkd Principles of Treatment:—!. Evacuation of thk Liquor Amnii; and, 2. Delivery by Turning. Proposal of a third Prin- ciple—the complete separation of the Placenta—Grounds for troposino IT—Illustrative Cases. Hitherto, two great principles of treatment,—if we leave out the minor details of management,—may be said to have been pur- sued by obstetric practitioners, in the treatment of placental pre- sentations. And the two modes of practice I allude to are sup- posed by many to be applicable to two different stages or degrees of the complication. They consist of the two following measures : 1. The Evacuation of the Liquor Am?iii. In some cases of placenta previa, and under some circum- stances, the artificial evacuation of the liquor amnii is recom- mended to be had recourse to, and thus the same treatment is followed for unavoidable'^ hemorrhage, as is followed by most practitioners in instances of accidental hemorrhage. This mode of practice has been especially applied of late to cases in which the presentation of the placenta was only partial, and where, con- sequently, a portion of the membranes was within reach, and to instances in which the hemorrhage was comparatively slight in its degree and effects. About a century and a half ago, the same treatment seems to have been employed also by some practitioners, in instances in which the placenta presented completely over the os uteri, the placental structure being perforated artificially with the finger or an instrument, in order to permit the liquor amnii to escape. After recommending, that in placenta prsevia, the mem- branes should be pierced, or the fingers thrust through the pla- centa, that at last it be perforated, and instead of the constant flux of blood which appeared before, the humours will presently flow out, Daventer,^ writing about the year 1700, adds, some peue- ^ The average mortality from lithotomy, on all hands, appears at present to be about one in eight.—Dr Willis' Urinary Diseases, 1838: p. 347. Mr luman has cal- culated the mortality from lithotomy to be 1 in every 7f cases, 765 patients having died out of 5900 operations which he had collected.—See Lancet for October 5, 1844. 2 The Art of Midwifery improved. London: 1715. Pp. 153-4.
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