Remarks on placenta prævia : with a case / by Alexander Milne.

  • Milne, Alexander.
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on placenta prævia : with a case / by Alexander Milne. Source: Wellcome Collection.

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    a serious flooding took place, accompanied with, or rather preceded by, pain. On my arrival at one o’clock P.M., I found the pains very moderate and slight, but recurring regularly, with a profuse escape of blood. Mrs L-was pale and agitated, and her pulse was somewhat feeble and frequent. She was, however, cheerful and hopeful, and this condition of mind I endeavoured to foster as an element contributing to her welfare. I gave her two ounces of brandy in a little cool tea. On examination, I found the os dilated to about the size of a florin, but rather rigid and unyielding. I could at once detect the placenta as the presenting part; and by making the finger describe its circumference, I could feel the placenta adherent all round the cervix. Its edge could not be felt in any one direction; no part more attenuated than another could be discovered; and as a matter of course no part of the membranes could be detected. Something bulky and hard could be felt on pressing up the placenta, but I could not be certain, but only con¬ jectured that it was the head. On withdrawing the fingers, they were profusely besmeared with blood, and clots came away from the vagina. I resolved to operate immediately, seeing that the haemorrhage wTas considerable on the accession of the pains. Chloroform was administered carefully by Mr Thomson, Nelson Street, who had joined me with Mr Suttie (both intelligent pupils at the New Town Dispensary) ,* and Mrs L-was brought to the edge of the bed. I then introduced my left hand gradually into the vagina, which (being a primipara) was very much con¬ tracted, until I reached the os. Two fingers found entrance ; but it took about half-an-hour of semirotatory movement to dilate suffi¬ ciently for the whole hand to pass, during which time I had to withdraw it twice or thrice on account of the fatigue occasioned by the compression of the os. Little blood, however, came away during the process, I then, after considerable force, separated— indeed almost tore—a portion of the placenta from the cervix pos¬ teriorly (this locality being preferred, as we had fancied we heard the pulsation of the foetal heart to the left of the middle line), when the membranes began to bulge, and were forthwith ruptured. I felt first the cord, then the head, and lastly reached a foot, and brought it down. The passage of the trunk demanded strong traction} and before the head was got clear of the exceedingly tight os by which it was firmly grasped, ten minutes elapsed, and the funis ceased to pulsate. Fifteen minutes having been occupied with the delivery of the child, and more severe traction being required than I ever remember to have used, with one or two excep¬ tions, and moreover, the cord having ceased to beat, I was pre¬ pared to find the child dead, but its heart was felt to pulsate, and I therefore committed it to the care of Mr Suttie, who by the usual means succeeded in restoring it in about half-an-hour. The placenta followed almost immediately, but no unusual flooding. Pressure was exerted over the uterus for a short time, and it con-