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London Medient Gazette,' anni 1829, impressa sunt. EXempla, numero tria, cum Summa diligentia acacumine, quoad Videtur, ObSerVata atque descripta sunt, et indicia in re tam obscura fortasse quam validissima offerunt, quod in duobus eXemplis tota placenta, in tertio pars amplior in utero permanenter remanserunt. Idem duo eXempla Commemorat a Golgonberger medico practico expertissimo He idolburgensi visa, de quibus hic Se persuasum habebat, that no trace of the placenta had beon' detected cither in a solid or in a partly dissolved
se state.' In his excerptis nulla de placentae remanentis fato hypothesis expresse offertur; sed dictum Prosessoris, exemplum aliud a Salmone medico BatavO-Lugdunensi visum animadvertentis: the whole placenta had been absorbed sententiam ejus indica re videtur. ObServandum est quoque medicum anglicum Rigby, illa eXcerpta in linguam suam vernaculam reddidisse, ut amicus Silus Merriman, medicinae doctor, testatur, ad sactum demonstrandum, proseSSorem Nagete eXempla quaedam ab-Sorptae placentae- Severat instances of the absorp- tion by the vesseis of the uterus of the reta ined placenta -vidisse. Absorptionis vero hac aut quacunque alia methodo nulla indicia prae se ferunt
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cxcerpta. Nihil aliud ex illis demonstrari potest
quam quod si agmenta placentae adhaerentiS nunquam, ut apparet, eX Utero CVRSerint. EX Omnibus autem auctoribus medico-obstetriciis,
qui Super hac re Scripserunt, nullus quod Sciam, hanc quaestionem tam directe consideravit quam amicuS meuS INGLEBY, medicus praeticus Birming-hamiensis, in opere suo, Λ Practical Treati se on Uterine Haemorrhage,' etc., anno 1832 publicato. In capite Suo XX i. de placenta disrupta On Disruption os the Placenta' medicus hic expertus sententia sua indicata, eXempla hujus casus interdum eXStare, quae naturae committere melius est,
quam ullum periculi augmentum per methodos artificias adhibitas provocare, ad sequelas varias diS- ruptae placentae describendas progreditur. Hic de absorptione possibili retentae partis, de ejus decompositione atque sub variis formis eXpulsione, denique de quadam eXceptione, ut dicit, huic naturae legi loquitur. Quod absorptionis fragmenti refert, cel. INGLEBYsententiae illae professoris Νagete, talem proceSSum per Vasa Uterina poSSibilem esse non adstipulatur; tametsi credit absorptionem in quibusdam perrariSexemplis, per lymphatica uterina propria fieri posse. Quod ad occasionem hujus, e placentae retentae de-
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compositae lege naturali, ut dicit, exceptionis, ab eo scriptum tanti est momenti, ut non possum Sequente pagina non describere. Hoc loco notare sufficiat, amicum meum 93stumatissimum medelam, Ut apparet, in nullo retentae placentae exemplo Videre, Si non per eventum perrarum absorptionis lymphaticpe. Verba ejus ad hanc rem Spectantia Sunt:-
through their calibros physicalty impossibie l
Grant ing thores oro that absorption reatly talios place, it must be allowed to be a rare occurrence, and can only bo essected by the proper uterine absorbenis.' Practical Treatise on Uterine Hoe-m0rrhage, CAP. XXi. pp. 206, 207. Ex omnibus his de fato placentae retentae Sententiis est inserendum, quod non nisi quadam digestiono aut absorptione' fragmenti, Puerperae re-
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valescentia speranda sit. Quam diversae autem hae sententiae sint, et quam conjecturales, speciali non eget notatione. Videatur ac Si non eX argumentis Sed argumentorum penuria tales conjecturae producerentur. Rebus Sic Stantibus, omnis Sententia ad phaenomenorum haud sucatorum confirmationem provocans conSideratione digna est; et arbitrio medicorum eruditorum officiose submitto, neceSSeeSt prius o Stendere, phaenomena Sub eXemplo primo deScripta, alia et meliori quam usus fui ratione explicari posse, quam ulla digeStionis aut absorptionis hypothesis accipienda sit. Phaenomena Similia tamen a cel. INGLEBY visa ab eodem parum simili rationse interpretata fuisse praetermittere non possum; accedit igitur officium, ante argumenta ulteriora adducenda, huius viri ingeniosissimi theoriam propriis verbis eXhibere. It has ali eady been observed that a retainod portion of placenta is usu Hly casi oss Doni tho utorias in a decomposed state. To this law os nature, hoWever, an eXception must be taken. Tho exception has resoren e both to the ordinary sorua os morbid adhesion, and also to a peculiar organisation of the retained SubStance, OCCISion- ing protracted and even satat cases Os hemorrhage,
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vhicli has not, Ι thin k, obta ined si ona any os our obstetric authors, a distinct notice. Although a considerable part of the placenta may Sometimes bo found in morbid association with the uterino Sursace, it more commonly happens, that Whilst the great bulli remaliis persectly healthy, a circum- scribed portion only shali have become dis organ- ised, and so firmiy and intimately inter overi With
iis connecting Sursace as to leave no distinci lino os domarcation. Under theso circumstances, WhilSt
tho placenta is boing delached by means of tho
funis, a portion of the mass may rema in sirinly adherent . . . Instead os the reta inod portion being cast os r by the progressive contractions os the womb, the connexion may be sufficiently close to resist these efforis os nature; the Orgin re- maining buthy, and the veSSeis Supplying the eX- traneous bolly unusualty large. Is the hemor- rhago is inconsiderabie, and tho constitutionaJ energies Unimpatred, the maSS, by acquiring an increased degree of organisation, presenis a florid hue, not unlike n fungous growth, in place of the blacti and offensive structure Whicli characterises a disrupted stato os the placenta. AloreOVer, the
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tho lining rnembrano os the uterus, aS to render a distinci and persect disianion impractic le. Practical Prealise, &c. cap. XXi. pp. 208, 209. Hac organisatione notabili congruimus ambo de- compositionem ac eXpulsionem fragmenti impossibiles reddi. Omni alio respectu dissentimus. Mea sententia est hanc organisationem in caUSa ConValeScentiae,-amici autem, in causa periculi atque mortis esse. Ad hunc finem dicit: Unless tho mass be completely Walled in , veS- seis Will be expossed; and though decomposition may Dot talie place, hemorroiage Will necessarily arise; and as the uterus cannot be persectly con- tracted, the cessation Os the hemorrhage must en- tirely depend upon the formation os coagula Within the vesseis. On the clois being displaced, the offusion Will bo renewed frona time to time.
Tunc sequitur, HuSdem argumenti CAUSA, CXemplum, phaenomena illa a me sub in Spectione post mortem puerperae ViSa quam proXime reserenS, his verbiS:-
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Dixi supra, virum hunc eruditum nullam medelam possibilem putare, placentae fragmento permn-nenter retento, niSi per eventum perrarum lymphaticae absorptionis. Haec mea interpretatio verum non omni dubitatione libera est. E phrasi supra Occurrente- protracted and even satat cases osse homorrhage' fortasse inserendum est amicum meum aeStumatisSimum non omnia hujus specialis organisationis exempla fatalia arbitrari. Contra Vero ConSideranda sunt, quod capite priori diXerat,
The patient is necessari ly exposed to dangers of the most formidabie hind. For although tho sorei gn body may be cast ost or absorbed possibiy without bucoming decoinposed, it is infinitoly more probable that stoOding, or decomposition and irritative sever,
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ot omnis causae medontis in his oXcerptis praetermissio. Si revera credit exempla quaedam hujus organisationis non lethalia evenire, cui cauSpe convalescentia adscribenda siti Si vero, ut videtur, omnia potius lethalia existimat; mihi nunc reStat quaedam meae sententiae, hanc organisationem modentem fore, documenta addere. 1. Haec mea sententia eX historia proceSSuum animalium, et medentium et morbosorum confirmari Videtur: ex. gr. eX illis inflammationum adhaesivorum eXempliS, Per quas Substantiae eXtraneae partibus animalium viventium conjunguntur. VariuStymphae coagulabilis usus, articulo fracto, ad Sequelas formidabiles cavitatum nudatarum praeVE-niendas, plura talis vis medicatricis naturae exempla elegantia profert. 2. Analogia insignis processui in eXemplo primo deScripto, Si non proceSsus ipse cum levi discrimine notatus, in illis conatibus a natura sactis ad periculum Separationis inter uterum et placentam, durante geStatione, ortae, obviandum eXhibetur. Hos conatus naturales tam lucide depinxit cel. RAMS-
ill tae 'place.' Vide Practical Trealiae, cap XX. pag. 20 l. II ic praeter expulSionem, aut absorptionem retentur Placenta nulla medetur causa nominatur.
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BOTHAM in praelectionibus Suis apud Hospitium Londinense habitis, ut meliuS sacere non POSSum, quam verba ejus ipsissima citare. Cases are not unfrequently met With in which two or three eruptions of blood having talien' place, consequent on Some eXternat and easily assignable cause, the hemorrhage gradually ceases, and does nos returia; but, under labour, adhesion os ille placenta is discovered. I presume, under Such circumstances, that these cessation of the dischargo dependS Upon an agglu- tination os the placenta With the uterus; nor is the explanation dissiculi. The two si faces remain in contaci, though not attached, having been Se- paraten froni caeli other by some accidental
ossori; inflammation is set up in the membrane
CauSa hujus uteri atque placentae agglutinationis ab eodem in priori pagina sic resertur. The last
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casu is tho most dissiculi os ait: that in vhicli morbid adhesion talios place-agglutination be-
position os coagulable lymph, the produce os a peculiar kind of inflamna atton, whicli the lining
membrane os the uterus has ta ken upon iiseis. De tenacitate majori vel minore ejus adhaesionis poStea loquitur, praeparationem anatomicam discipulis exhibens :- Here i S a case Where a portion of the placenta was so fritily attached to the ute- rine sursace that it could not by any means be removed; nay, Ι have operaed more than one body, Where a part of the placenta was test adhe- rent to the uterus, and where, on mahing a longi- tudinal section os the organs, and eXamining the cui edges, I could not determine the boundary lino belween tho uteruS and the placenta. Prael. Xlvi. opere Supra citato, pp. 7ql, 742. Si firmissima agglutinatio in hoc eXemplo ViSa, atque per lymphae coagulabilis depositionem effecta,
conatus Stren us vis medicatricis natu rori ad hoemorrhagiam obviandam a que vitam Servandam durante
gestatione dici possit, quid est cur dubitemus talem agglutinationem medentem etiam POSt par-