Remarks on placenta prævia : with a case / by Alexander Milne.

  • Milne, Alexander
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on placenta prævia : with a case / by Alexander Milne. Source: Wellcome Collection.

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    at stool almost infallibly renews the flooding. It will be observed that the preparation employed was the pernitrate. This is doubtless the most suitable, for while tonie it is also one of our most reliable astringents, and by selecting it we are enabled to dispense with the other medicinal haemostatics, such as gallic acid, tannic acid, and acetate of lead, which, though excellent astringents in many cases., often impair the tone of the alimentary canal, and rendei the patient unable to partake of those nutritious foods which are so essential in cases of this nature, or to assimilate them if taken. Yes, their use —the use of those astringents which are not tonics—may be said to be an abuse, for by them, while bestowing benefit, you entail also evil?_evil which it is to be feared outweighs the good. But, further, while it was of the utmost importance in this case to stimulate highly in the afore-named way, medicinally and dietetically, with the view of repairing waste, of replacing lost blood, guarding at the same time against undue stimulation when the flooding was going on, it was of no less moment to act decisively and promptly when labour pains supervened, for then was the most critical time. This I think it will be seen was done, and with the best result; and here I should like to make a remark or two on the treatment to be adopted at this stage—the preliminary treatment, so to speak— that which, as a rule, these cases being generally premature, we have to face or encounter before the turning or the removal of the placenta, whichever treatment we elect can be proceeded with. Well, then, haemorrhage is going on and increasing with every recurrent pain, until a scant enough supply mayhap is left for the maintenance of the cardinal vital acts, and yet the os remains rigid. Entrance must be had with a view to efficient action, yet a gateway, so to speak, interposes, and bars admission. What, then, is to be done ? Shall we apply the tampon and wait, or tunnel our gradual and 'cautious, yet persistent way, until the os dilates so as to admit the hand? I incline to the latter plan, and would recommend it. It was thoroughly successful in this case, and one or two others that have come under my observation. Some authorities in London where they were as long a period in understanding or appreciating chloroform as the siege of Troy lasted, if they yet thoroughly apprehend it — some gentlemen there, and over in the capital of the verdant isle, and in other places, are very chary about fingering the os;1 they are almost as much afraid to handle it as the rustic was to cherish the frozen viper, or as some of pur surgeons are to try the needle instead of the thread in arterial bleeding. They say that it is fraught with danger, and clinch the statement with the threadbare aphorism (profoundly true in some circumstances and cases) that “a meddlesome midwifery is bad.” Now, with all respect for these oracles, who are certainly less ambiguous 1 “ Almost all the English authorities, Dr Collins and all the Irish, object to digital interference for the purpose of dilating the cervix.” (See Churchill s Midwifery, 4th ed., p. 252.)
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