The puerperal diseases : Clinical lectures delivered at Bellevue Hospital / By Fordyce Barker.

  • Barker, Fordyce, 1819-1891.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: The puerperal diseases : Clinical lectures delivered at Bellevue Hospital / By Fordyce Barker. 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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    and intimate morbid adhesion, it may not be possible to accomplish this. Bnt this I will say in unqualified terms, that every physician should know whether or not he has left a portion of the placenta behind, and he is justly censurable when he is ignorant on this point. Hemorrhage from this cause is liable to come on at any period, from the third day up to the end of the month. Indeed, some cases, and even fatal ones, have been re- ported where the hemorrhage did not recur until five or even six weeks after delivery. I shall have occa- sion, hereafter, to speak of septicaemia, another dan- ger from retention of a portion of the placenta, but at the present time I shall confine my remarks to the hemorrhage. This results, from the cause mentioned, chiefly in the three following methods: (1.) By pre- venting complete and entire contraction of the uterine fibres, at that point where a portion of the placenta remains adherent; (2.) by keeping up an increased de- termination of blood to the orsran, and thus retarding involution; (3.) when the retained portion is detached, whether three days or three weeks after delivery, the utero-placental vessels are left open to pour out blood. When you know that a portion of the placenta has been left behind, you will of course be on the alert to pre- vent hemorrhage, and to arrest it, should it come on. It is to be inferred that you have secured as complete contraction as possible, during the first three day-. Then I should recommend to you, as a precautionary measure, to give the ergot and nux-vomica thrice a day for three or four days, as I believe that this not only assists in keeping up the contraction of the uterine fibres and in diminishing the capillary circulation of the uterus, but also that it accelerates that metamor- phosis of tissue which we call involution. I may, at