The principles and practice of obstetric medicine / Carefully revised & corr., with ... additions and notes by Alexander Cooper Lee and Nathaniel Rogers.

  • Blundell, Dr., 1790-1878.
Date:
[1840]
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of obstetric medicine / Carefully revised & corr., with ... additions and notes by Alexander Cooper Lee and Nathaniel Rogers. Source: Wellcome Collection.

    143/1188 (page 119)
    now been laid aside ;—probably not without good reason. It seems, therefore, to be pretty well agreed on, among those who are com- petent to form an opinion, that, though we are not injudiciously and rudely to tear away the placenta, it is, nevertheless, requisite that some artificial assistance should be given; and the ereatest and nicest, perhaps the most important of all questions, in the management of a natural labour, is the discrimination of the moment at which this assistance ought to be interposed. Shall we interfere immediately ? Shall we wait for an hour? Or shall we delay still longer, before the placenta is brought away ? By different practitioners, different rules have been prescribed ; and as they have their excellencies as well as their defects, I shall now briefly explain them. Some there are, and I think Dr. Hunter was of the number, who recommend that we should take our rule from ¢ime; and this has the advantage of being a rule of easy and exact application ; for the chronometer* becomes our oracle. * Wait,” they say, till four hours after the birth of the child. If the pla- centa come away before the four hours have elapsed, it is well; if, on the other hand, it should still remain in the cavity of the uterus, manual interferencé, become necessary. There are others who judge by the pains; without any regard to the time at which the woman has been delivered. Pains,” they gay, “accompany the’ contractions; the contractions expel the pla- centa; the pains, therefore, indicate the time at which artificial assistance should be interposed.” These practitioners, therefore, after delivery, seat themselves at the bed-side of the patient ;—re- fraining, for one or two hours, from manual interference, if no pains eccur; but as soon as the pains commence,—following in the track of Nature, our best instructress,—they lay hold of the umbilical cord, and endeavour to bring the placenta away. Nor is this rule to be despised. _ There are other practitioners who follow a very different rule;— a rule not without its excellence; determining whether they shall or shall not assist the birth of the placenta, by the situation of that viscus; without regard to the pains, or to the time which has elapsed since the delivery. If, on examination, they feel the placenta lying in the upper part of the vagina, and through the os uteri; and, more especially, if they feel the union of the cord with the placenta,—they do not hesitate to remove it; while, on the other hand, if the umbi- lical cord ascend high into the uterus, and no part of the placenta can be felt, they wait. Of the three rules here enumerated, I think on the whole, that the last is to be preferred. In ordinary cases, the medical attendant never can err in abstracting the placenta, when it lies, ina great measure, out of the uterus; while there is always risk in its removal of this organ, when it lies in the fundus of the uterus; and not only a risk, but a difficulty. Lastly, there are some, who,—without regard to the situation of the placenta, —with- gut regard to the pains,—without regard to the time that has elapsed * From xpovos, time ; and perpew, to measure.