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

  • West, Charles, 1816-1898.
Date:
1847
Catalogue details

Licence: Public Domain Mark

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

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ■ items, and the ovarian and hypogastric trunks, regurgitating towards the avity of the organ. Bleeding from the lacerated openings in the veins is becked as well by a peculiarity in the structure and arrangement of these essels as by the constriction of their orifices by the uterine fibres. This pe- uliarity, noticed by Mr. Owen, in vol. iv, of the collected edition of Hunter’s A’orks, and more recently by Air. Goodsir, consists in the arrangement of the eins in successive tiers or planes, the veins of the lower tier communicatino- vith those of the upper, by very oblique openings in the floor of the latter’, vbile the opening into the lower vein is partially covered by a semilunar pro- ection, formed by the lining membrane of the two venous tubes as they meet ogether at a very acute angle. It is probable, moreover, that these semilunar irocesses act something in the manner of the Eustachian valve, and thus urther contribute to prevent the regurgitation of blood from above down- vards. Another circumstance, which is not without its influence in diminish- ing the tendency to hemorrhage after the expulsion of the placenta, is that the lerivative power which attracted the blood downwards into the placental cells io longer exists; and this having ceased, the blood will be more likely to flow n the onward current, and by direct channels, than to pass through the less ree communications which exist between two different tiers of veins. The for- mation of coagula in the collapsed veins, and the presence of tufts of foetal c essels, or remnants of decidua blocking up their openings, likewise contribute o the same result. It is obvious that these facts, assuming them to be cor- ectly stated, lend much support to Ur. Simpson’s opinion, which was also ntertained by the late Dr. Hamilton, that the main bleeding in cases of pla- tenta prsevia takes place not from the uterine surface, but from the placental r rifices of the lacerated veins, from which the blood would escape in its na- ural onward course, unchecked by any contractile power in the veins them- elves, or in the tissue by which they are surrounded. Dr. Radford,* Dr. Ashwell,f and an anonymous correspondent of the .''Medical Gazette,’J writing from Glasgow, under the signature of J. B., at- tack this theory of the source of the hemorrhage in placenta praevia as being L hysiologically impossible. Whether correct or not, however, this theory avolves no contradiction of ascertained anatomical facts; its alleged incom- •atibility with the account given by W’eber, Wagner, and others, evidently asts on a misunderstanding of Dr. Simpson’s statement. The pamphlet of M. Negrier,§ though written with the express object of xplaining the causes of presentation of the placenta, and of laying down ules for the management of cases of hemorrhage from that source, contains ittle either new or valuable. The supposition that the placenta becomes at- ached to the cervix uteri, in consequence of the ovum having entered the comb while the decidua was as yet unformed, and having consequently gra- dated to the lowest part of its cavity, has often been entertained, though o\v regarded as an inadequate, probably, an altogether incorrect explanation f the occurrence. The fact, too, that the fibres of the cervix are differently rranged from those of the body of the uterus, and that the cervix is likewise Ossessed of a smaller amount of contractile power, have both been long nown, although brought forward as novelties by M. Negrier. The papers on the subject of placenta praevia, by Drs. Simpson and Lee,|| re occupied chiefly witli the exposure of statistical errors into which each onceives the other to have fallen, and leave the main question ol the pro- riety of detaching the placenta before the birth ol the child, much as it tood last year. The interest of the subject, however, has led to the public * Med. Gazette, Nov. 14, 184.5. t Ibid., Nov. 7, 1845. J Ibid., Nov. 21, 1045. $ Recherches et Considerations sur la Constitution, et les Fonctions du Col de 1 Uterus, <sc. vo, Paris et Angers, 1846. I Med. Gazette, Sept. 19, Oct. 10, 24, and Nov. 7,1846.