Some remarks on the treatment of unavoidable hæmorrhage by extraction of the placenta before the child : with a few observations on Dr. Lee's objections to the practice / by J.Y. Simpson.

  • Simpson, James Young, 1811-1870.
Date:
[1845]
Catalogue details

Licence: Public Domain Mark

Credit: Some remarks on the treatment of unavoidable hæmorrhage by extraction of the placenta before the child : with a few observations on Dr. Lee's objections to the practice / by J.Y. Simpson. Source: Wellcome Collection.

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    connection with the complete detachment of the placenta, or with consequences arising directly from it; and if we did admit the 3 remaining cases, (which are doubtful), as leading by this occurrence to a fatal ter¬ mination, they would still only constitute a mortality from this complication of 3 in 141,-—or of about 1 in 47 cases. These facts tend strongly to shew that the artificial and complete detachment of the placenta would in all probability be in some cases and varieties, at least, of una¬ voidable haemorrhage, accompanied with much saving of maternal life. I know fur¬ ther, that in several instances recorded by Collins, Ramsbotnam, Lowenhardt, &c. this treatment had been followed with suc¬ cess, when perchance it had been had re¬ course to by midwives, and others, under supposed mismanagement, and in ignorance and defiance of all the established rules of practice in this special complication. I subjoin in a foot-note* the details of a case of this description very kindly forwarded to me, some time since, by Mr. Cripps of Liverpool. I insert it as, at one and the same time, illustrative both of the preceding remark, and of some of the other observa¬ tions which I have already offered. Exactly a year ago, I had an opportunity of putting, for the first time, to the test of experience, the practice which the foregoing remarks all lead to suggest, of detaching, and, * “I was sent for-Mr. Cripps writes me—a few days a^o, about 8 p. m., to see a poor woman wlio supposed herself to be at the early part of the last month of pregnancy with the third child. She had had occasional flooding to no great ex¬ tent for a week previously. On the morning of the day on which I saw her, a surgeon had been sent for in consequence of the occurrence of several labour pains, together with a good deal of haemorrhage. This gentleman being out of town, his assistant went; he remained with her during the day, and in the evening, finding things not going on so favourably as he wished, he sent for a friend of his employer’s, who, soon after his arrival, sent for me. On making an examina¬ tion, I found an arm down, which was much swollen, and the pains very severe. I immediately gave one drachm of laudanum, and on their sub¬ siding, turned without much difficulty. The fu¬ nis was divided, only about four or five inches re¬ maining, and appeared as though it had been cut. On expressing my surprise at this circum¬ stance, I was informed that it was cut when the after-birth was taken away, about 10 in the morning. Not believing it possible that such could be the case, there having been no hemorr¬ hage whatever from that hour until the period of delivery, I searched for the other portion of the navel-string, but not finding it, and being again assured that “ the after-birth had come in the morning,” I introduced my hand into the ute¬ rus, and made a most careful examination; it was contracting satisfactorily, but was perfectly empty. I watched her strictly until her complete recovery. I had every portion of discharge saved for my inspection, and am therefore perfectly satisfied that this is a case in which the placenta presented, and was removed 10 hours previously to the birth of the child, and that, in the mean¬ time, there teas no hemorrhage whatever.” if necessary, extracting the placenta and not the child in unavoidable hsemorrhage. The lady (a patient of Mr. Hill of Porto- bello), was taken in labour between the 7th and 8th month of pregnancy, and, in con¬ sequence of the severity of the discharge, was blanched and prostrated when I first saw her. The vagina was filled with coagula, and the os uteri was, in consequence of its small size and great height, reached and passed with difficulty, so as to ascertain fully the presentation of the placenta. Anterior to it I was able after a short time to reach and rupture the membranes. Not¬ withstanding this, however, along with the exhibition of ergot, &c., the discharge and sinking continued to go on. It seemed very difficult and dangerous to attempt to turn in consequence of the state of the os, and as the edge of the after birth was offer¬ ing to protrude through it, I separated and gradually extracted the whole placental mass. Fi'om the time that this was accomplished all haemorrhage ceased. The cord was cut, and the placenta removed from the bed. The infant came down slowly, and was safely expelled about two hours afterwards. The mother made a perfect and speedy recovery. Similar cases of the successful adoption of the same practice have, since the period at which my paper appeared in Dr. Cor- mack’s Journal, been published by Mr. Wilkinson, Mr. Greenhow, Mr. Jones, and Dr. Maclean. In all these instances the mothers were saved, and rapidly recovered. Dr. Lever and Dr. Bird have informed me within the last week, of two other recent suc¬ cessful instances of the same practice. In the course of a short time it seems not unreasonable to expect, that we may havea sufficient number of cases recorded, to enable us to judge with greater certainty and precision of the merits of this plan of treatment, and of the par¬ ticular placental complications to which it may be specially applicable. The proposal of the practice of separat¬ ing and extracting the placenta before the child in unavoidable haemorrhage, and thus (to use the expressions of Dr. Robert Lee), “ departing from the rule (of turning the child) which has been established in the treatment of cases of placental presentation for the last two hundred years,” and “ sub¬ verting the established^ rules of practice in the treatment of cases of such vital impor¬ tance,” has, as might naturally be expected, given rise to considerable discussion and difference of opinion. In the Medical Gazette for September 19th, I find that Dr. Lee has entered his present dissent against the proposed treatment. The tone and character of Dr. Lee’s remarks might save me from the necessity of offering any answer to them ; but, for the sake of the practice under dispute, I shall correct in de-