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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![3. lu nineteen out of twenty cases in which it has happened the attendant hemorrhage has either been at once altogether arrested or it hi\s become so much diminished as not to be afterwards alarming. „ , , . 4. Tlic presence or absence of flooding after the complete separa- tion of the placenta does not seem in any degree to be regulated by the duration of time intervening between the detachment of the placenta and the birth of the child. 5. In 10 out of 141 cases, or in 1 out of 14, the mother died after the complete expulsion or extraction of the placenta before the child. 6. lu seven or eight out of these ten casualties the death of the mother seemed to have had no connection with the complete detachment of the placenta, or with results arising directly from it; and if we do admit the three remaining cases, which are doubtful, as leading by their occurrence to a fatal tei-mination, they would still only constitute a mortality from the complication of three in 141, or of one in 47 cases. 7. On the other hand, under the present (1844) established rules of practice, 180 mothers died in 654 cases of placental presenta- tions, or nearly one in three. He fii-st deliberately put the method in practice on the 1st of October, 1844, but the placenta had been artificially removed by others previous to Simpson, and cases are recorded as instances of malpractice by Collins, Ramsbotham, Cripps (of Liverpool), Lowen- hardt, Baudelocque, &c. Ramsbotham describes a case so graphically that it is worth recording in his own words. He was summoned by a doctor to come and help him in a case he was attending, but before Ramsbotham left his house he received a second message from the doctor saying that he need not come, as the woman was better aud doing well. When on next meeting the doctor he asked what wa-s the nature of the ca.se, the following conversation ensued. It was the strangest case 1 ever saw ; it was a placental present- ation with the most violent flooding, but I got it away. Got what away, says Ramsbotham. Why the placenta, says the doctor. What, before the child V asked Ramsbotham in astonish- ment and horroi'. Yes, before the child, said the doctor, and the flooding ceased and the woman did well, and the child soon followed the after-birth. Simpson thought the placenta was tlio source of the bleeding ; this, however, has now been established not to be the case, as the hsomorrhage comes from the open mouths of the uterine vessels, and Barnes has drawn attention to the fact that in the majority of cases it is not necessary to separate the wliole placenta, for there is a natural spontaneous arrest of htemorrhage attained when that ])art of the placenta which has grown within the lowci- v.one has hecn detaclicd, provided uterine contractions](https://iiif.wellcomecollection.org/image/b22294375_0009.jp2/full/800%2C/0/default.jpg)
