On the so-called fatty degeneration of the placenta / by James M. Cowan.

  • Cowan, James Moffat.
Date:
1854
Catalogue details

Licence: Public Domain Mark

Credit: On the so-called fatty degeneration of the placenta / by James M. Cowan. 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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    with in states of inflammation only, are met with so fre- quently, it becomes a difficult task to enumerate the morbid conditions in which they do not occur. That this lesion is not of an inflammatory character may be proved first of all by the general symptoms. Now shivering frequently occurs in the course of this disease, and some have grasped at this as indicative of inflammation. But rigors alone, in the absence of other febrile symptoms, such as pain in the belly, hot sldn, bounding pulse, great thirst, &c., cannot be held as proving unconditionally a state of inflammation. In these circumstances they prove merely a derangement of the nervous system. By way of illustration let me instance the case of rigors occurring at the end of the first stage of natural labour. Who has seen anything of ob- stetric practice, and has not witnessed such a phenomenon ; nay, perhaps frequently, and to a degree sufficiently intense 1 Yet who, in the absence of other febrile symptoms, ever thought shivering in these circumstances symptomatic of a type of metritis, or an indication for the use of the lancet. So in this case of disease of the placenta the patient no doubt shivers, but this is, as I have already stated, dependent on the intense sympathy which exists between the uterine and general system of the woman, and is caused by the irritation of the extravasated matter on the interior of the uterus. She presents, in addition, coldness of the surface of the body in place of heat; a depressed and weak, in place of a bound- ing pulse ; thirst no doubt sometimes ; and no pain on pres- sure over the seat of the placenta. In the face of such symptoms, who would argue the case was one of inflamma- tion, acute or chronic, or be prepared to adopt the usual antiphlogistic treatment! The circumstance which militates most against the inflammatory theory of this lesion, is to be found in the fact, that a placenta so affected is never found preternaturally adherent to the interior of the uterus. It is contrary to all pathologists of the present day know regard- ing the results of the inflammatory process, to conceive it possible that such layers of coagulable lymph as are some- times seen deposited between the uterus and placenta, could exist there without giving rise to the same results, as is generally seen when lymph is effused between two solid sub- stances. In the ten cases which happened in ray experience, not only was the placenta non-adherent, but it seemed to be unusually less adherent than commonly, for in several of the cases the whole of the contents of the uterus were expelled simultaneously. Another anomaly exists, which is diffi- cult to be accounted for, if the inflammatory theory be ac-