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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    cation of cases in which the placenta was spontaneously expelled before the) child, as well as to its artificial detachment in various instances, where tliei experiment was conceived to be justifiable. Eleven cases are mentioned,* in | which the spontaneous expulsion of the placenta occurred, the accident having happened twice to the same woman. All the mothers survived, except one, who died of the effects of the loss of blood on the 8th day. Nine of the children were still-born, one was very feeble at birth and died in a few hours, and one survived. The interval between the expulsion of the placenta and the birth of the child is stated in 7 cases. I’ll rice the interval did not exceed a very few minutes, once it was ten minutes, once half an hour, and once three hours. The hemorrhage appears to have ceased in every instance on the expulsion of the placenta, but in both instances in which the child was born alive its birth followed almost immediately on the expulsion of the pla- centa. Seventeen instances have been recorded in the English Journals! during the past fifteen months, of detachment of the placenta before the birth of the child, in cases of placenta praevia. In the case recorded l>v Dr. Simpson, to whom it had been communicated by Mr. Cripps, the placenta was removed by an ignorant midwife, and 10 hours elapsed before the child was born, during which time, however, no hemorrhage took place. In 16 out of the 1/ cases the bleeding is said to have ceased immediately on the detachment of the placenta, but Dr. Everitt mentions that although the flooding abated on the ' separation of the placenta, it did not entirely cease until after the application . of cold externally ; and he insists on the'fact as proving that in cases of this kind, the hemorrhage comes from the uterine as well as the placental ends of the lacerated veins. The life of the mother was preserved in every case but one, and then the previous hemorrhage had been so profuse as almost to ex- haust the patient, who died 3 hours after delivery. All the children were still-born, except in the case related by Mr. Stiekings. [As far as the well- doing of the mother is concerned, the results of these cases must be regarded as favorable ; but, on the other hand, the lives of 17 out of 18 children were sacrificed, at least half of whom would probably have been saved by the ordi- nary practice. In many instances, too, there appears to have been no reason why the child was not turned and extracted first; the os uteri having been well dilated, or yielding and dilatable. In such cases it seems not unfair to assert that the child’s life was sacrificed to the desire of performing a new operation. Several of the cases are so loosely worded that little can be ga- thered from them, while some have either been so carelessly observed, or so incorrectly related as to render them quite untrustworthy.] The opinion expressed by some practitioners, and acted on by more, that the new mode of treatment is generally applicable, and to be preferred to the ordinary practice, is opposed both by Mr. Crowfoot]; and Dr. Radford,§ the latter of whom disclaims having recommended the detachment of the placenta before the birth of the child except under special conditions, these being the death of the child, the existence of so great a degree of exhaustion from loss of blood, as to render the ordinary mode of proceeding impracticable, or ■ * Goddard, Lancet, Dec. 3,1845; Parker, Prov. Med. Journ., Sept. 24, 1845; Favell, ibid., Aug. 20, 1845; Ileid, Med. Gazette, Nov. 25, 1845; Tweed, Lancet, Jan. 3, 184(i; Ley, Prov. Med Journal, April 22, 1846 ; Russell. Ed. Med. Surg. Journal, July, 1846, p. 52; and Burwell, Amer. Journ. of Med. Science, April, 1846. t Wilkinson, Prov. Med. Journal. July 23, 1845 ; Walker, ibid., Sept. 3 ; Greenhow, ibid., Sept. 10, 1845; Maclean, Northern Journal, Aug., 1845 ; Radford, Med. Gaz., Oct. 24, 1845; Jones, Lancet, Sept. 27, 1845 ; Wells, ibid., Nov. 8; Brown, ibid., Dec 27, 1845 ; Simpson, Med. Gazette, Oct. 10. 1845, p 1011, note; Hutchinson, Prov. Med. Journal, Oct. 15, 1845; Houghton, Lancet, Jan. 24, 1846; Stiekings, Med. Gazette, May 8, 1846; Wales, Prov. Med. Journal, April 8, 1846 ; Bryan, ibid., June 17,1846; Jay, Med. Gazette, Aug. 21, 1846; Everitt, Prov Med. Journal, Sept. 30, 1846. t Prov. Med. Journal, Nov. 12, 1845. « Ibid., Aug 13,26; and Med. Gaz., Nov. 21,1845.