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.

    16/40 (page 14)
    Negrier’s own results, (he lost 4 patients out of 8) form the best comment on doctrines, which, but for the reputation of the author, would not have been noticed.] A controversy has been carried on in Italy, which does not seem to have attracted much attention in other parts of the continent, between Dr. Bellini, of Florence, and some of his countrymen, with reference to the treatment of placenta prsevia.* Dr. Bellini advocates the making1 incisions into the os uteri, in cases of hemorrhage from this source, in order to allow of the early introduction of the hand, and consequent early delivery of the patient. He condemns the use of the plug in these cases as being a means either wholly inefficient, or at best, suppressing the bleeding only for a short time, while it favours the occurrence of internal hemorrhage. On the other hand, incisions have often been made into the os uteri for the express purpose of enabling the practitioner to deliver his patient immediately, and no bad results have followed from this proceeding, even in cases where the use of the forceps has been needed to accomplish delivery. The four instances in which Dr. Bellini resorted to incision of the os uteri were not cases of placenta praevia, and it has accordingly been objected by Ciniselli, that the state of the os uteri, when the placenta is attached around it, differs from its condition in ordinary labour, it being thick and vascular, and consequently likely to bleed danger¬ ously if incised. The other arguments for and against incision of the os uteri, and in favour or in dispraise of the plug present nothing remarkable. Mr. Dorringtont relates two cases, and Dr. Radfordf one, of the successful employment of galvanism to excite uterine action in accidental hemorrhage. In each instance the agent seems really to have had the effect attributed to it; but Dr. Radford’s case is the most conclusive, since rupture of the membranes had been previously resorted to without the uterine action being in the least degree excited by it. Another case is recorded by Mr. Johnson§ of its em¬ ployment to check dangerous hemorrhage from the uterus, a month after miscarriage. A very interesting case is related by Dr. Pagan,|| in which hemorrhage, after the expulsion of the placenta, appears to have been kept up by that body having been partially developed within the fallopian tube. The placenta was disrupted, and the hand, when introduced into the uterus, removed a portion, 2 inches long by half an inch broad, and expanding into a surface 2§ inches in breadth from one side of the fundus of the organ. He supports his opinion as to this deviation from the natural seat of the placenta being an occa¬ sional cause of flooding, by the detail of another case in which the patient died of peritonitis, she having had hemorrhage after delivery, for which the placenta was extracted, though lacerated in so doing. After death a portion of pla¬ centa, 3^ inches long, was found at the orifice of the tube, attached around its margin, and projecting far into its cavity. Some similar observations have been made by Riecke and d’Outrepont, to which Dr. Pagan refers. Mr. Adams^T has written some essays on floodings after delivery, and their treatment, which arc remarkable for their opposition to all hitherto received opinions on the subject. He asserts that in the majority of cases hemorrhage after delivery does not result from want of uterine contraction; that the blood does not proceed from the interior of the uterus at all, but from the rupture of vessels about the os tincse, or more frequently about the vulva, during the passage of the child. * An account of part of this controversy is given by Schreiber, Neue Zeitschr. f. Geburtsk., xvii, 2tes Heft; besides which theie are, an essay by Bellini, in Gaz. Med. di Milano, Nov. 15, 1S45, and a defence of the use of the plug by Barbieri, in the same number of the journal; and by Casazza, ibid., Aug. 15, 1846. + Prov. Med. Journal, March 11, 18, 1846. X Med. Gazette, Jan. 2, 1846. § Prov. Med. Journal, March 25, 1846. II Monthly Journal, Nov., 1845. <jj Med. Gazette, Aug. 29, 1845, Jan. 23, 1846.