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.

    9/14 page 7
    an easy matter. For example, in pushing up the fingers and applying force, the placenta, as I have found, instead of giving way, resiles, there being no counter-force—no resistance behind—nothing beyond that which it is enabled to offer as the result of its attach¬ ment to the cervix; you merely indent and extend it a bit, instead of tearing it through. The same thing often happens (and the analogy is suitable and striking) with the bag of membranes; for do we not often find these, though highly attenuated—though vastly thinner—resisting our attempts to perforate them with the finger, until the force of the water behind helps us to effect the rupture? Of course, a soft and friable afterbirth will be more easily penetrated. Take now the dangers. These are by no means light. Instead of perforating, you may push up the entire placental mass; or, if you force your successful way, the aperture may be too contracted for the child easily to pass ; or, again, you may tear extensively the placental vessels ; and in either case, not to speak of maternal risk, the result is the exposure of the ehild to certain peril, and almost to certain death. The sweetness, therefore, said to spring from the saving of a life, is likely to be exchanged for the unwholesome bitterness inseparable from the losing of it in a case where loss was certainly not inevitable. I would disapprove of this plan, therefore, and only adopt it if driven to it (like the tempest-tossed vessel going to the nearest port), which misfortune can happen to us but seldom indeed—can happen to us only, in fact, if we fail to separate the placenta, or part of it rather, from its attachment to the cervix. The Mother.—Coming now to the mother, who happily made a good recovery in the sense of rallying well from debility and having no untoward after-symptoms, while not pretending to claim credit for this, I may yet be pardoned for speculating briefly on the probable causes of her welldoing. During the ten weeks of her haemorrhagic history she lost a good deal of blood, yet at the end of this period—that is, up to the commencement of labour—she was not reduced to very great feebleness, though she certainly was some¬ what blanched-looking, and felt faint and giddy at times. Her pulse was not very firm, but it was not strikingly frequent. For a few days after the discharge she was a good deal prostrated, but she rallied again before a renewal of the flooding. I would simply ask, then, under this head, how much might be due to the dietetic treat¬ ment—the soups and the wine, etc.—and how much to the iron ? The question is doubtless more easily put than answered, for in cases of this nature we cannot altogether eliminate conjecture. I for one, however, lay stress on the iron (and my patient was certainly well plied with it); it is a blood-making medicine emphatically, and, as we often see in ansemic cases, brings back in a few weeks the ruddy glow to the blanched and pallid cheek. There is an obvious caution in connexion with its use, viz., to obviate its con¬ stipating effect, every few days, with gentle laxatives, as straining
    digitised image 1
    digitised image 2
    digitised image 3