Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1845-6 / by C. West.

  • Charles West
Date:
1847
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Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1845-6 / by C. West. Source: Wellcome Collection.

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    the presence of some mechanical obstacle to the extraction of the child. He further condemns the employment of a sound, or of any instrument for de¬ taching the placenta, and urges that the operation should be undertaken only when it can be accomplished by the finger, and when the introduction of the hand into the uterus has become practicable. Previous to this, the application of cold, but above all, the employment of the plug must not be omitted. These limitations would reduce the cases suited for the new plan of treatment to a very small number, but it must be borne in mind that Dr. Simpson* himself is very far from recommending it as always applicable, but confines it to those cases where rupturing the membranes is insufficient, and where turning is either impracticable or extremelv dangerous. The cases in which he would practise it, are those in which the os uteri is rigid and undilated, the uterus too contracted, or the woman too exhausted for turning to be safely performed, or where the pelvis is contracted. Further, he would adopt it when the child is premature, or has been ascertained to be dead, and also in the greater number of cases of first labour, or of labour coming on before the 7th month. Professor Osiander, of Gottingen,f is the only continental writer who has noticed this question, and he objects most strongly to the practice of detach¬ ing the placenta before the child, on the ground of its necessarily involving the death of the child, while he doubts, though apparently not on the ground of facts observed by himself, whether the practice be a certain means of arresting hemorrhage. Many isolated cases are related of the successful treatment of placenta praevia by turning the child. Preferences are not made to them in this Report, because the mere fact of that plan being adequate in the majority of instances is generally admitted, while nothing but a most elaborate analysis of cases of both kinds would render any inferences as to the comparative value of the two modes of treatment, drawn from their statistics, at all trustworthy. This is well illustrated by a statement of Mr. Russell’s,]; that he saved all the mothers, and 6 of the children, in 7 cases of placenta praevia that occurred in his private practice, while he lost 5 women out of 29 to whom he was called in consultation. The different results here depended not on the treat¬ ment, but on the time of its adoption. Mr. Dorrington§ has related a case of placenta presentation in which he employed galvanism with apparent advantage, but the patient had not pre¬ sented any very alarming sjmptoms, and galvanism was not employed alone, but in conjunction with rupture of the membranes, so that it is not easy to determine to which of these measures the excitement of vigorous uterine action, and consequent arrest of the hemorrhage, are to be attributed. Dr. J. H. Oavis|| animadverts on Dr Simpson's omission of all mention of the plug, as a means to be employed in the management of cases of placenta praevia, and insists on its extreme value in controlling hemorrhage until the state of the os uteri is such as to allow of turning. M. Ndgrier,^[ likewise, extols the plug, but at the same time he absolutely condemns the rupture of the membranes, since the cervix uteri being possessed of but little contrac¬ tile power would not, in his opinion, close the bleeding vessels. In cases of central insertion of the placenta, he advises that the hand be introduced through it rather than to one side, since, by the former plan, the mother will lose less blood, while the foetus will generally be born alive, if delivery be expeditiously accomplished. He recommends, moreover, the forcible dilatation of the os uteri, in all cases where women have previously given birth to children, since he thinks that in them it seldom offers any considerable resistance. [M. * Med Gaz., Oct. 10, 1845, p, 1013. ’ J Loc. cit. 1] Lancet, Nov. 8, 1845. + Neue Zeitschr. f. Geburtskunde, xix, 3tes Heft. § Prov. Med. Journal, March 11, 1846. Lib. cit., p. 133-170.