Licence: Public Domain Mark
Credit: The treatment of placenta praevia / by James Murphy. 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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![ncss by means of a curved wooden stethescopc, the diagnosis is only rendered positive by introducing the finger through the os, and touching the phxceutal mass. When the diagnosis is thus established positively, or even when we have strong presumptive evidence of its existence, how should we proceed ? Tliis is the first point to consider in the treatment of placenta prsevia, and it is one which I trust the members who take part in the discussion will consider the importance of; and the question at once resolves itself into whether labour should he brought on then and there, or an endeavour made to prolong the pregnancy to its normal period. The older writers recommend the latter course, and we are told to keep the patient on a hard mattresis, to apply astringents and cold to the vagina, to give cold and acidulated drinks, and exhibit opium and even ergot. But though a portion of this treatment may be all very well in not at least increasing the hajmorrhage, we must bear in mind that all this time the patient is in great and imminent danger. In spite of all these precautions, htemorrhage may occur at any time, and must occur when labour sets in, and we cannot foresee when it may take place, or calculate in what quantity it will pour out; and it may be, and often is, so sudden and so terrible, that death occurs before assistance can be obtained, or that the patient is so exhausted that assistance, when it comes, is powerless to save life. I would imj^ress on this Society that the horrible mortalit}- in placenta pra)via is not due so much to the impotence of our art as it is to violent hfemorrhage occurring before assistance cau be obtained, or where that assistance is of a helpless do-nothing char- acter. Why, then, should we hesitate to bring on jjrematurc labour at oucc when jjlacenta prasvia is diagnosed, when by means of Barnes's bags we can safely bring on labour at any time or fix the time as easily as for an ovariotomy or lithotomy, and bring a skilled assistant to help ns in the operation and to share the responsibility? If this be desirable, as it is, in the case of men who make obstetrics a special study, how much more advantageous is it in the case of the immense number of practitioners who have no peculiar 2^enc]mnt for midwifery, but loathe and detest it, and merely regard its practice as one of the stern and unpleasant necessities of what we are pleased to call tlie noblest and most-self-sacrificing of professions. Playfair, Lusk, Barnes, and most modern writers suggest, if they do not actually advise, this active mode of procedure. But it may be objected to on the grounds that it lessens tlie chances of the child's life : let us see how f;ir this holds good—Miiller finds, as the result of his extensive and most important investigations, published iu Stuttgart iu 1877, that the hajmorrhage occurs in greatest fre- quency fi'om the 28th to 36th week in complete presentation, and iu the incomplete varieties most frequently after the 32nd week,](https://iiif.wellcomecollection.org/image/b22294375_0006.jp2/full/800%2C/0/default.jpg)
