CHAPTER IX.

_Difficulties from the_ Placenta _or_ Secundines.

The _Placenta_ or _After-birth_, being from any violent Shock or Accident, more or less, _separated_ from its Seat, during any Time of Breeding, will produce a Flooding, in Proportion to its Quantity, _dangerous_, which is sometimes so violent, as to occasion Death in an Hour’s Time; and nothing but _instant_ Delivery can prevent it. When the Case is not so desparate, as all the _Blood_ in the Mother’s Body, necessary to support her own and Infant’s Life, may be drain’d away, the Consequence may be equally fatal in a more lingering Way.

The 26th _Feb._ 1748, I was sent for to a Woman at MOUNTAIN-DEVEREL, within about Five Weeks of her Time, in a violent Flooding; her Midwife gave her an Opiate, which she thought check’d her Flooding, excepting that once a Week, it became very violent, for about three Weeks past; when I came, the Neighbours told me she had lost a Pail full of Blood; the poor Woman was so weak, that her Pulse were scarcely perceptible, and her Voice but a Whisper; I was unwilling to meddle, for fear she should die under my Hands, but yielded to the Importunity of her Friends: It was with great Difficulty I introduced the _Tops_ of my two Fore-fingers and Thumbs into the _internal Orifice_, which I gradually dilated, ’till I could pass my Hand, when by _turning_, I brought away a _dead_ Child, depriv’d of its Nutriment by the great Loss of its _maternal_ Blood; but had considerable Trouble in getting the _After-birth_, by Reason of its _Adhesion_: After Delivery, the Flooding immediately very much abated, the poor Woman reviv’d to Admiration, and I left her the next Day, as well as could be expected in so low a Circumstance, tho’ dubious of her Recovery: I heard she died five or six Weeks after; but I am well satisfied, had she had an earlier Recourse for Assistance, she might have recover’d.

In these Cases, Midwives are too apt to trust to their own Judgments, instead of calling for better Assistance; and tho’ they have Recourse to external _Applications_, _Ligatures_, and _Opiates_, these Things, injudiciously practis’d, are frequently more detrimental than beneficial: For Instance, should the _Arteries_ be compress’d by too tight a Ligature of the _Arms_ and _Legs_, the _Flooding_ would become more violent.

When ignorant Midwives, by rashly pulling the _Navel-string_, break it, or by the Adhesion of the _After-birth_, find it out of their Power to bring it away, they are apt to persuade People, it will come without further Help, which seldom happens; on the Contrary it most frequently occasions Death, more or less suddenly, or Hecticks and Consumptions, when left to corrupt in the Body: The _Uterus_ sometimes so strongly contracts about, and embraces it, that it may be impossible, after a few Hours Delay, to procure it, as I found in a Case that occur’d to me at COLEHORN, the 30th _Sept._ 1748, tho’ little more than four Hours passed, from the Time the Midwife broke the _String_ close to the _Placenta_, for the Part of the _Uterus_ next the _Placenta_ was so contracted, as barely to admit the _Tops_ of my two Fore-fingers; I endeavour’d, with all possible Caution, to make a larger Aperture, but in the ill _Situation_ of the _Uterus_, at the Extent of my Reach, all my Attempts were in Vain; this Woman rested well the succeeding Night, and had no extraordinary Complaints when I left her in the Morning, first prescribing what I thought most suitable to her Condition: I afterwards heard she died with a Frenzy, succeeding a _Suppression_ of the _usual_ Purgations; where the Corruption of the _Placenta_ takes Place, the Case is, at least, more Chronical, and the _Secundines_, gradually wasting, come away Piece-meal, the Patient labouring under a Hectick from the Contagion of putrid Humours, mixing with the circulating Fluids.

I have at other Times, after a longer Delay, been more successful; the 28th _December_, the same Year, I was call’d, by Order of the late Lord WEYMOUTH, to the Assistance of a poor Woman at HORNISHAM, whose _After-birth_ had been retain’d three Days; she had contracted a Fever from its Putrefaction, which was so great, that scarcely any Body could bear the Room, and had lost a great deal of Blood by Flooding; the poor Woman soon recover’d after her Delivery, in the Use of a little Medicine, from his Lordship’s House: I have seldom found the Business difficult, when speedily call’d in the like Cases.