The principles and practice of obstetricy, as at present taught, by James Blundell ... To which are added, notes and illustrations. By Thomas Castle.

  • Blundell, Dr., 1790-1878.
Date:
1834
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of obstetricy, as at present taught, by James Blundell ... To which are added, notes and illustrations. By Thomas Castle. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    there: there is reason to believe that lymphatics are wanting altogether in the placenta, and, therefore, we should not expect to find them in the funis.* It seems, then, that the umbilical cord is in its composition exceedingly- simple, made up, apparently, of the vessels, a cellular web, filled with a sort of gelatinous material, and by which cellular web those vessels are bound together, and of a membranous sheath, or prolongation of the chorion, here- after to be spoken of, and which gives a covering to the cord from one extre- mity to the other. Of this membrane you may observe the thinness, the smoothness, the firmness, when you are bringing away the placenta; for when you lay hold of the funis, this membrane is lying in your hand. In the thickness of the funis, which depends upon the quantity of mucus contained in the cells, more than upon the size of the vessels, there is much variety in different subjects; hence the cord may be unusually small, or on the other hand, very large. In the latter case, Mauriceau considers it pro- per always to apply two ligatures, instead of one, on the portion which remains attached to the child, for it has happened,! that by the shrinking of the cord under the ligature, the child has died from haemorrhage. Upon the umbilical cord we sometimes meet with knots,! and, if I may confide in reports received, sometimes two or three§ knots may be found upon the cord at once. To Dr. Hunter I may refer you for a very plausible explanation of the formation of these knots when single, for he has suggested that the umbilical cord, at birth, may perhaps form a coil round the margin of the os uteri within, and that the fcetus, in passing the orifice of the uterus, may, at the same time pass through the loop, carrying the umbilical extre- mity of the cord along with it, so as to form the knot at the very moment when the body passes into the world. And this explanation enables us to under- stand well enough how a single knot may be formed ; but then how is it that two or three knots are produced ? how that a knot may be found on the cord in the earlier months, though the foetus has never left the cavity of the uterus ? Really the solution of this knot may remind one of that Gordius, or of the knot scarcely less notorious, knit by the hand of Obadiah, fated to bring to light that comprehensive code of imprecations, the contents of which his liberal master so generously showered down upon every part of his person. The origin of the cord is the navel; its termination is the placenta, where its insertion is commonly central, though it sometimes unites with the placenta at the margin, or intermediately. And this I the rather wish you to notice, because when the insertion of the cord is marginal, you might be led to imagine that one-half of the placenta had been torn away, the other half still remaining in the uterine cavity. An eccentric insertion of the cord at the ab- dominal extremity is more rare, and yet now and then even this variety is observed, the cord springing from the one or other side of the abdomen.j| The point is curious, but in a practical view it seems to be of small obstetric import. * Diembroeck, Michaelis, Schraeger, and Wrisberg, imagined they discovered lymphatics.— Dr. Ryan. t A case of this kind has been described by Deglaud. X Illustrated by a preparation in Dr. Blundell's Museum. § Mr. Rogers, an American, and a student at these Hospitals, informed me, that at New York, a case had occurred where three knots were on the funis, and yet, notwithstanding these knots, injection could be thrown from one end of the cord to the other without difficulty.—Dr. Blunddl. J Jl A preparation of the umbilical cord, entering the abdomen of the foetus laterally, may be seen m Dr. Blundell's Museum.