Some remarks on the treatment of unavoidable hæmorrhage by extraction of the placenta before the child : with a few observations on Dr. Lee's objections to the practice / by J.Y. Simpson.

  • Simpson, James Young, 1811-1870.
Date:
[1845]
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Licence: Public Domain Mark

Credit: Some remarks on the treatment of unavoidable hæmorrhage by extraction of the placenta before the child : with a few observations on Dr. Lee's objections to the practice / by J.Y. Simpson. Source: Wellcome Collection.

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    SOME REMARKS ON THE TREATMENT OF UNAVOIDABLE HAEMORRHAGE EXTRACTION OF THE PLACENTA BEFORE THE CHILE. WITH A few Observations on Dr. Lees Objections to the Practice. By J. Y. SIMPSON, M.D. F.R.S.E. PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF EDINBURGH. From the London Medical Gazette, October 10, 1815. All the more severe forms of uterine haemorrhage that are liable to occur in the later periods of pregnancy, and during delivery, are generally allowed, by obstetric pathologists, to depend upon the separation of a greater or less portion of the placenta from the interior of the uterus. When such a separation takes place, two surfaces are exposed, namely, first, a part of the inner surface of the uterus, and, secondly, the corresponding part of the outer, or maternal surface of the placenta. Both of these exposed surfaces present a number of open vascular orifices left by the laceration of the utero-placental vessels which formerly con¬ nected them. From which set of open vascular orifices—the uterine or the pla¬ cental—does the resulting haemorrhage principally proceed ? Most accoucheurs seem to believe that the blood effused in those haemorrhages which occur before or during labour, comes from the exposed uterine orifices. “It is (observes Dr. Lee) from the great semi¬ lunar, valvular-like, venous openings in the lining membrane of the uterus, which you have seen in various preparations, and of [from] the arteries which are laid open by the separation of the placenta, that the blood alone flows in uterine haemorrhage.”—(Lec¬ tures on Midwifery, p. 361.) But arteries, particularly when they are so long and slender as the utero-placental arteries are, do not give rise to any marked degree of haemorrhage when they are lace¬ rated or torn through ; and bleeding does not readily occur from the venous openings exposed on the interior of the uterus, be¬ cause venous haemorrhage by retrogression (which the blood escaping backward into the uterine cavity would be) is here pre¬ vented by a variety of anatomical and sub¬ sidiary means, which I have elsewhere taken occasion to describe at some length. In the passage that I have quoted above from Dr. Lee’s published Lectures, Dr. Lee does not allow that the blood, in uterine haemorrhage, proceeds in any degree from