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.

    12/14 page 10
    as prone to run into the hypersemic state as a modest maiden is to blush, or a cherry to redden in summer,—and it certainly has not been dipt, like Achilles, into any charmed stream to make it invul¬ nerable. But yet, as before said, we find it, at least in the normally developed or gravid state, wonderfully tolerant of a long and liberal handling; and surely, too, the soft, gentle, and well-belarded fingers going up cannot be more calculated to injure than the hard head coming down, which descent is sometimes so impetuous and forcible as to lacerate the cervix, or even tear away a portion of the uterus itself;1 the womb being thus its own destroyer—committing felo de se. Of course, when nature performs a painful prank of this kind, there is no one to blame; it is all right, and at the same time all wrong. There is another thing to be noticed in connexion with this dilating process, viz., that, contrary to what might be expected, little blood is lost during its performance, the hand, as has been pointed out by different observers, proving a pretty effectual tampon of itself.2 The Tampon.—But now about the plug; what is its true worth and value in these cases ? Will it arrest the haemorrhage effectually and entirely ? Certainly, we may stuff the vagina as full as an egg, plug it so securely with sponge or cotton wool that no blood may flow externally, but will internal bleeding be thus prevented? I suspect not.3 The reason is this, that the uterus is never, even at the full time, entirely filled by the ovum, but, on the contrary, room and verge exists and is created sufficient to contain an amount of blood fitted almost to prove fatal. Plugging, then, is not a very reliable plan here, so far as the conservation of blood is concerned— which is indeed the paramount concern; and in resorting to it, it is to be feared, we perpetrate something not unlike the folly of the ostrich when she plunges her head in the sand; we merely hide from our vision the danger that besets us. Yes ; we shut out from our view the bleeding that is going on,—a discharge that, of course,. 1 Cases of this kind are reported by Dr E. Kennedy, Dr Davis, Dr Johnstonr and others. 2 u By the pressure it exerts on the open vessels.”—Ramsb. 3 Dr Ramsbotham says, in his work (Obst. Med. and Surg., p. 414), “ that by using the plug much blood may be collected within the cavity of the womb, even to the induction of a fatal termination.” Merriman (Synopsis, p. 127) says he thinks the plug ought not to be used when the bulk of the uterus exceeds that of a pregnancy of three or four months. Gardien (Traits des Accouchmens, tom. ii., p. 419) also objects to the plug;, as did also Dr Hamilton. In Dr Lees’ Clinical Midwifery, several cases are related where the plug was employed,—for example, cases 43 and 58, but without success, or, in other words, without saving blood. Dr L. in many cases also, instead of waiting for the dilatation of the os, chose rather to per¬ form craniotomy! I for one would certainly work hard at manual dilatation before resorting to this extreme, which, however, may have frequently saved the mother’s life.
    digitised image 1
    digitised image 2
    digitised image 3