On the expulsion and extraction of the placenta before the child in placental presentations / [Sir James Young Simpson].

  • James Young Simpson
Date:
1845]
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Licence: Public Domain Mark

Credit: On the expulsion and extraction of the placenta before the child in placental presentations / [Sir James Young Simpson]. Source: Wellcome Collection.

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    ON THE EXPULSION AND EXTRACTION OF THE PLACENTA BEFORE THE CHILD, IN PLACENTAL PRESENTATIONS. P BY J. Y. SIMPSON, M.D., PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF EDINBURGH, &C. To the Editor of the Provmcic SlR, The propriety and practibility of the complete separation and extraction of the placenta before the child, in cases of “ unavoidable haemorrhage,” is a sub¬ ject which has engaged my attenton for a considerable time past. I might have printed some years since a series of cases illustrative of my views on the subject, but I have hitherto abstained from doing so, under an anxious wish that before venturing to publish the results of the enquiry, I might be able to collect as many individual facts as possible, in order to have a sufficiently broad and solid basis, for the important deductions which seemed to me, from the first, to flow from the investigation. I believe the data I have gathered together, now consisting of 135 cases, to be ample enough to show :— 1st. That the complete separation and removal of the placenta before the child is very seldom followed by any great hemorrhage. 2nd. That, on the other hand, the previously existing haemorrhage almost always ceases from the moment the placenta is 'perfectly and completely detached from its connections with the uterus. 3rd. That the cessation of the haemorrhage is expli¬ cable, not on the idea that the descending head of the child acts as a plug or compress upon the exposed orifices of the uterine sinuses, but on the mutual vascular economy of the uterus and placenta, and the circmstance that the haemorrhage principally comes from the partially detached surface of the latter. 4th. That the placenta may be, and ought to be, detached from its connections with the uterus in some varieties of unavoidable haemorrhage, and that these varieties are for the most part exactly those in which our present recognized methods of treatment are most inapplicable and most unsuccessful. 5th. That under such circumstances the practice would in all probability be attended with much saving of maternal life. 6th. That this treatment has been in repeated in¬ stances accidentally followed with complete success, when had recourse to by midwives and others, under supposed mismanagement, and in defiance of the established rules of treatment in this special compli¬ cation. And, 7th. In one very dangerous case, in which the pre¬ vious haemorrhage was great, and continued in despite of the evacuation of the liquor amnii, and where the os uteri was imperfectly dilated, I adopted, as a matter of principle and choice, the plan of separating and extracting the placenta, with complete success, the Medical and Surgical Journal. flooding immediately ceasing, though the child was not expelled for about two hours, and the mother recovering without one bad symptom. Whilst, with the kind assistance of some of my professional friends, here and elsewhere, diligently col¬ lecting data for the testing and establishment of the opinions which I have just stated, the practical infer¬ ences at which, at an early part of the inquiry, I have arrived, have in the meantime been laid before the public as original, by more than one member of the profession, and that in quarters from whence I cer¬ tainly least expected it. In order that the subject of priority may be set right, as far as the valuable pages of your Journal are concerned, I will feel obliged by your inserting in an early number, the following extract from the minutes of the Medico-Chirurgical Society of Edinburgh, and the accompanying correspondence on the question between Dr. Radford and myself. I have the honour to be. Sir, Yours very faithfully, J. Y. SIMPSON. Edinburgh, Jan. 25, 1845. Extract from the Minutes of the Meeting of the Medico- Chirurgical Society of Edinburgh,, for December Ath, 1844. ON THE SPONTANEOUS EXPULSION AND ARTIFICIAL EXTRACTION OF THE PLACENTA BEFORE THE CHILD, IN PLACENTAL PRESENTATION. By PRO¬ FESSOR Simpson. Professor Simpson gave a communication on the expulsion and extraction of the placenta before the child, in cases of unavoidable hemorrhage. He showed, that in common cases of presentation of the placenta, when managed according to the rules gene¬ rally followed under the circumstances, the mortality among the mothers was very great. Out of one hundred and seventy-four cases, tabulated from dif¬ ferent authors, by Dr. Churchill, this complication had proved fatal to forty-eight mothers; and a more extensive table of three hundred and thirty-nine, drawn up by Dr. Simpson himself, presented a mortality of one hundred and fifteen mothers; or, one out of every three died. In contrast with these statistics, Dr. Simpson brought forward a number of cases, (some previously recorded, and others collected from private sources,j in which the placenta had come away before the infant, either expelled by the natural efforts alone, or in conse«